Modified lecithin-cholesterol acyltransferase enzymes

ABSTRACT

The invention provides compounds, pharmaceutical compositions and methods for treating atherosclerosis, coronary heart disease, thrombosis, and for decreasing or prevention of accumulation of cholesterol in a subject by modifying LCAT polypeptide.

FIELD OF THE INVENTION

This invention relates generally to the field of medicine and, morespecifically, to compositions and methods for treating coronary heartdisease, atherosclerosis, inflammatory disorders and disordersassociated with thrombosis.

BACKGROUND OF THE INVENTION

Over 50 million Americans have cardiovascular problems, and many othercountries face high and increasing rates of cardiovascular disease. Itis the number one cause of death and disability in the United States andmost European countries. By the time that heart problems are detected,the underlying cause, atherosclerosis, is usually quite advanced, havingprogressed for decades.

Atherosclerosis is a polygenic complex disease of mammals characterizedby the deposits or plaques of lipids and other blood derivatives in thearterial walls (aorta, coronary arteries, and carotid). These plaquescan be calcified to a greater or lesser extent according to theprogression of the process. They are also associated with theaccumulation of fatty deposits consisting mainly of cholesterol estersin the arteries. Cholesterol accumulates in the foam cells of thearterial wall, thereby narrowing the lumen and decreasing the flow ofblood. This is accompanied by a thickening of the arterial wall, withhypertrophy of the smooth muscle, the appearance of foam cells and theaccumulation of the fibrous tissue. Hypercholesterolemia can thereforeresult in very serious cardiovascular pathologies such as infarction,peripheral vascular disease, stroke, sudden death, cardiacdecompensation, cerebral vascular accidents and the like.

The cholesterol is carried in the blood by various lipoproteinsincluding the very low-density lipoprotein (VLDL), the low-densitylipoproteins (LDL) and the high-density lipoproteins (HDL). The VLDL issynthesized in the liver and is converted to LDL in the blood, whichmakes it possible to supply the peripheral tissues with cholesterol. Incontrast, the HDL captures cholesterol molecules from the peripheraltissues and transports them to the liver where they are converted tobile acids and excreted. The development of atherosclerosis and the riskof coronary heart disease (CHD) inversely correlate to the levels of HDLin the serum. Gordon et al. (1989) N. Engl. J. Med. 321: 1311; Goldbourtet al. (1997) Thromb Vasc. Biol. 17: 107. Low HDL cholesterols oftenoccur in the context of central obesity, diabetes and other features ofthe metabolic syndrome. Goldbourt et al., supra. It has been suggestedthat low HDL cholesterol levels are associated with an increased risk ofCHD, while high concentrations of HDL have a protective effect againstthe development of premature atherosclerosis. Gordon et al. (1986)Circulation 74: 1217. Studies demonstrated that the risk for developingclinical atherosclerosis in men drops 2-3% with every 1 mg/dL increasein the concentration of HDL in plasma. Gordon et al. (1989) N. Engl. J.Med. 321: 1311. It has been established that concentrations of LDLcholesterol can be reduced by treatment with statins, inhibitors of thecholesterols biosynthesis enzyme 3-hydroxyl-3-methylglutary Coenzyme Areductase and thereby this treatment has been used as a successfulapproach for reducing the risk for atherosclerosis where the primaryindication is high LDL level. However, it remains unclear whetherstatins are beneficial for patients whose primary lipid abnormality islow HDL cholesterol.

Lecithin-cholesterol acyltransferase (LCAT) is an enzyme which catalysesthe esterification of free cholesterol by the transfer of an acyl groupfrom phosphatidylcholine onto 3-hydroxyl group of the cholesterol,forming cholesteryl ester and lysophosphatidylcholine. McLean et al.(1986) Proc. Natl. Acad. Sci. 83: 2335 and McLean et al. (1986) NucleicAcids Res. 14(23): 9397. LCAT is synthesized in the liver and secretedinto the plasma, where it is combined with HDL, called anti-atherogeniclipoproteins. These HDL particles have the capacity to accept the excesscholesterol, which is then esterified by LCAT in the HDL particles. Thecholesteryl ester molecules in the HDL particles are either transportedto the liver directly through SR-BI receptor, or transferred toapoB-containing lipoproteins, including very low density lipoproteins(VLDL) and LDL, mediated by CETP, and then transported to the liverthrough LDL-receptor pathway. This mechanism, called reverse cholesteroltransport (Glomset (1968) J. Lipid Res. 9:155), allows the removal ofexcess cholesterol from the body, and therefore is involved in theprevention of atherogenesis. LCAT plays a key role in this process bycreating a gradient of free cholesterol between the plasma membranes andthe circulating lipoproteins.

This invention provides modified LCAT proteins with increased enzymaticactivity and/or stability and methods for treatment of coronary heartdisease, atherosclerosis, inflammatory disorders and disordersassociated with thrombosis using these modified LCAT proteins.

SUMMARY OF THE INVENTION

Provided herein are modified LCAT proteins comprising an amino acidsubstitution in a wild type LCAT protein amino acid sequence. In oneaspect, the modified LCAT protein is more enzymatically active than thewild type LCAT protein from which the modified LCAT protein is derived.In another aspect, the modified LCAT protein increases levels of highdensity lipoprotein (HDL) to an extent that is greater than the wildtype LCAT protein from which the modified LCAT protein is derived. Inanother aspect, the modified LCAT protein is more stable in vivo, orless immunogenic than the wild type protein from which it was derived.

In one embodiment, the modified LCAT protein comprises an amino acidresidue substitution at position 31 in SEQ ID NO: 1 or at a position inan ortholog wild-type LCAT protein amino acid sequence corresponding toposition 31 in SEQ ID NO: 1 is substituted. In various aspects, themodified LCAT protein is derived from wild type human, rabbit, monkey,hamster mouse or rat LCAT protein.

In another embodiment, the modified LCAT protein is derived from a wildtype LCAT amino acid sequence set out in SEQ ID NO: 1, and includes asubstitution at position F1, L3, L4, N5, L7, C31, N384 or E416. Invarious aspects, the substitution is F1A, F1G, F1I, F1L, F1M, F1P, F1V,F1C, F1Y, F1T, F1Q, F1N, F1H or F1D. In other aspects, the substitutionis L31, L3F, L3C, L3W or L3Y. In still other aspects, the substitutionis L4A, L4I, L4M, L4F, L4V, L4W, L4Y, L4T, L4Q or L4R. In still otheraspects, the substitution is N5A, N5M, N5H, N5K, N5D or N5E. In yetother aspects, the substitution is L7M, L7F or L7E. In other aspects,the substitution is C31A, C31I, C31M, C31F, C31V, C31W, C31Y, C31T, C31Ror C31H. In still other aspects, the substitution is N384C, N384Q orE416C.

In other embodiments, the modified LCAT protein comprising asubstitution at position C31 in SEQ ID NO: 1 and a substitution at aminoacid residue position F1, L4, N5, V28, P29, G30, L32, G33 or N34. Invarious aspects, the substitution is F1A, L4F, N5E, N5Q, N5D, N5A, V28A,V281, V28C, V28T, V28R, P29G, P29F, P29T, G30A, G301, L32A, L321, L32M,L32F, L32C, L32W, L32Y, L32T, L32S, L32N, L32H, L32E, G331, G33M, G33F,G33S, G33H, N34A, N34C, N34S or N34R. In other aspects, the substitutionat position C31 is C31A, C31I, C31M, C31F, C31V, C31W, C31Y, C31T, C31Ror C31H. In one aspect, the modified LCAT protein comprises a C31Ysubstitution and an addition substitution F1, L4, L32, or N34, and incertain aspects, these substitutions are F1S, F1W, L4M, L4K, N34S, L32F,or L32H.

In still other embodiments a modified LCAT protein described hereinfurther includes a vehicle, and in various aspects, the vehicle is animmunoglobulin constant (Fc) region or a water soluble polymer, or morespecifically, a water soluble polymer that is polyethylene glycol.

In other embodiments, a modified LCAT as provided herein includes aregion of wild type LCAT protein amino terminal amino acid sequence thatis duplicated and covalently attached to a terminus of the modified LCATprotein. In one aspect, the region of wild type LCAT protein aminoterminal amino acid sequence is 10 to 15 amino acids in length. In otheraspects, the region of the wild type LCAT protein amino acid sequence isduplicated and covalently attached to the amino terminus of the modifiedLCAT protein, the carboxy terminus of the modified LCAT protein, orboth.

Also provided are pharmaceutical compositions comprising a modified LCATprotein as provided here and a pharmaceutically acceptable carrier.

Method of treating an LCAT-related disorder are also provided comprisingthe step of administering an amount of a modified LCAT protein providedherein in an amount effective to treat said disorder. In differentembodiments, the modified LCAT is administered intravenously oradministered by bolus. In various aspects in the methods of treatment,the LCAT-related disorder is atherosclerosis, inflammation, thrombosis,coronary heart disease, high blood pressure, LCAT deficiency syndrome,Alzheimer's disease, corneal opacity, metabolic syndrome, dyslipidemia,myocardial infarction, stroke, critical limb ischemia, and/or angina.

Also provided is a method for increasing HDL cholesterol in a subjectcomprising the step of administering to the subject a therapeuticallyeffective amount of a modified LCAT protein provided herein.

The invention further provides a method for preventing accumulation ofcholesterol in a subject comprising administering a therapeuticallyeffective amount of a modified LCAT protein as provide herein.

DESCRIPTION OF THE DRAWINGS

FIG. 1A-1J provides Genbank Accession numbers for wild type LCATproteins amenable for producing modified LCAT proteins.

DETAILED DESCRIPTION OF THE INVENTION I. Definitions

The term “LCAT” or “lecithin-cholesterol acyltransferase,” as usedherein, refers to a wild type glycoprotein enzyme that catalyzes thesynthesis of cholesterol esters and lysolecithin fromphosphatidylcholine and unesterified cholesterol present inlipoproteins. This enzyme is produced primarily by the liver andcirculates in blood reversibly bound to lipoproteins. Human LCAT (SEQ IDNO: 1; Genbank Accession No. AAB34898) has a polypeptide mass of 49 kDa,or around 67 kDa with added carbohydrate mass. Various LCAT amino acidsequences for obtaining a modified LCAT protein useful in this inventionare represented in FIG. 1A-1J.

Human LCAT (SEQ ID NO: 1; Genbank Accession No. AAB34898) FWLLNVLFPPHTTPKAELSN HTRPVILVPG CLGNQLEAKL DKPDVVNWMC YRKTEDFFTI WLDLNMFLCLGVDCWIDNTR VVYNRSSGLV SNAPGVQIRV PGFGKTYSVE YLDSSKLAGY LHTLVQNLVNNGYVRDETVR AAPYDWRLEP GQQEEYYRKL AGLVEEMHAA YGKPVFLIGH SLGCLHLLYFLLRQPQAWKD RFIDGFISLG APWGGSIKPM LVLASGDNQG IPIMSSIKLK EEQRITTTSPWMFPSRMAWP EDHVFISTPS FNYTGRDFQR FFADLHFEEG WYMWLQSRDL LAGLPAPGVEVYCLYGVGLP TPRTYIYDHG FPYTDPVGVL YEDGDDTVAT RSTELCGLWQ GRQPQPVHLLPLHGIQHLNM VFSNLTLEHI NAILLGAYRQ GPPASPTASP EPPPPE

The term “modified LCAT” refers to lecithin-cholesterol acyltransferaseas defined above, wherein one or more amino acids in the wild type LCATprotein is substituted with another amino acid, or one or more aminoacids is added to the either end or the middle of the wildtype LCAT fromwhich the modified LCAT protein is derived. Modified LCAT proteinscontemplated have improved pharmacokinetic properties compared to thewild type LCAT protein from which the modified LCAT protein is derived.More specifically, a modified LCAT protein has either (i) increasedenzymatic activity compared to wild type LCAT protein from which themodified LCAT protein is derived as measured in the same in vitro assayconditions, (ii) increased ability to increase HDL levels in vivocompared to wild type LCAT protein from which the modified LCAT proteinis derived, (iii) increased plasma stability or half-life time, i.e.,increased circulatory half-life, compared to plasma stability of wildtype LCAT protein from which the modified LCAT protein is derived,and/or (iv) decreased immunogenicity (i.e. evokes less of an immuneresponse) compared to wild type LCAT protein from which the modifiedLCAT protein is derived. Assays for measuring LCAT enzyme activityinclude, e.g., use of apoAI-liposome assay and use of plasma LCATactivity assay, which determine cholesterol esterification rate in anartificial system and in a physiologically relevant system,respectively. Assays for measuring LCAT stability in vivo include ELISA,which determines the half-life of recombinant LCAT protein in the bloodafter LCAT protein administration. Biologically active fragments of amodified LCAT protein are contemplated to the extent that the fragmentincludes the amino acid change(s) introduced into the wild-type LCATamino acid sequence.

The terms “derivatizing,” “derivative” or “derivatized” compriseprocesses and resulting modified LCAT proteins in which, for example andwithout limitation, (1) the compound has a cyclic portion; for example,cross-linking between cysteinyl residues within the compound; (2) thecompound is cross-linked or has a cross-linking site; for example, thecompound has a cysteinyl residue and thus forms cross-linked dimers inculture or in vivo; (3) one or more peptidyl linkage is replaced by anon-peptidyl linkage; (4) the N-terminus is replaced by —NRR₁, NRC(O)R₁,—NRC(O)OR₁, —NRS(O)₂R₁, —NHC(O)NHR, a succinimide group, or substitutedor unsubstituted benzyloxycarbonyl-NH—, wherein R and R₁ and the ringsubstituents are as defined hereinafter; (5) the C-terminus is replacedby —C(O)R₂ or —NR₃R₄ wherein R₂, R₃ and R₄ are as defined hereinafter;and (6) compounds in which individual amino acid moieties are modifiedthrough treatment with agents capable of reacting with selected sidechains or terminal residues. Derivatizing a modified LCAT protein doesnot further change the modified LCAT protein amino acid sequence, exceptto the extent that derivitization includes addition of one or more aminoacid resides at the carboxy terminus of the modified LCAT protein aminoacid sequence, the amino terminus of the modified LCAT protein aminoacid sequence, or both the carboxy terminus and the amino terminus ofthe modified LCAT protein amino acid sequence. In addition, a modifiedLCAT protein can be derivatized with a side chain modification to anamino acid residue, with the proviso that the side chain modification ofcysteine at position 31 in the wild type human LCAT sequence, andcorresponding cysteine residues in human homologs and orthologousproteins as identified by amino acid sequence alignment, includingnecessary gaps, are excluded from the scope of the invention. Further,it will be understood that whenever “modified LCAT protein” is mentionedherein, a modified LCAT protein derivative is also contemplated for thataspect of the invention described.

The term “pharmacologically active” means that a substance so describedis determined to have activity that affects a medical parameter (e.g.,blood pressure, blood cell count, cholesterol level) or disease state(e.g., atherosclerosis, inflammatory and thrombosis disorders).

The term “physiologically acceptable salts” comprises any salts that areknown or later discovered to be pharmaceutically acceptable. Somespecific examples are: acetate; trifluoroacetate; hydrohalides, such ashydrochloride and hydrobromide; sulfate; citrate; tartrate; glycolate;and oxalate.

“Substantially homogenous” as used herein with reference to apreparation of the invention means that the preparation includes asingle species of a therapeutic compound detectable in the preparationof total therapeutic molecules in the preparation, unless otherwisestated at a specific percentage of total therapeutic molecules. Ingeneral, a substantially homogenous preparation is homogenous enough todisplay the advantages of a homogenous preparation, e.g., ease inclinical application in predictability of lot to lot pharmacokinetics.

“Bioefficacy” refers to the capacity to produce a desired biologicaleffect. Bioefficacy of different compounds, or different dosages of thesame compound, or different administrations of the same compound aregenerally normalized to the amount of compound(s) to permit appropriatecomparison.

“Atherosclerosis” refers to a condition characterized by the hardeningand/or narrowing of the arteries caused by the buildup of athermatousplaque inside the arterial walls. The atheromatous plaque is divided inthree components, (1) the atheroma, a nodular accumulation of a softflaky material at the center of large plaques, composed of macrophagesnearest the lumen of the artery; (2) underlying areas of cholesterolcrystals; (3) calcification at the outer base of more advanced lesions.Indicators of atherosclerosis include, for example, the development ofplaques in the arteries, their calcification, the extent of which can bedetermined by Sudan IV staining, or the development of foam cells inarteries. The narrowing of the arteries can be determined by coronaryangioplasty, ultrafast CT, or ultrasound.

“Inflammation” or “inflammatory disorder” refers to a localized,protective response elicited by injury or destruction of tissues, whichserves to destroy, dilute or wall off (sequester) both the injuriousagent and the injured tissue. The term “inflammatory disease” or“inflammatory condition” as used herein, means any disease in which anexcessive or unregulated inflammatory response leads to excessiveinflammatory symptoms, host tissue damage, or loss of tissue function.Additionally, the term “autoimmune disease,” as used herein, means anygroup of disorders in which tissue injury is associated with humoral orcell-mediated responses to the body's own constituents. The term“allergic disease,” as used herein, means any symptoms, tissue damage,or loss of tissue function resulting from allergy. The term “arthriticdisease,” as used herein, means any of a large family of diseases thatare characterized by inflammatory lesions of the joints attributable toa variety of etiologies. The term “dermatitis,” as used herein, meansany of a large family of diseases of the skin that are characterized byinflammation of the skin attributable to a variety of etiologies. Theterm “transplant rejection,” as used herein, means any immune reactiondirected against grafted tissue (including organ and cell (e.g., bonemarrow)), characterized by a loss of function of the grafted andsurrounding tissues, pain, swelling, leukocytosis and thrombocytopenia.

“Thrombosis” and “thrombosis-related disorder” refer to abnormalthrombus formation that causes obstruction of blood vessels andconditions associated with such obstruction. Blood vessels operate undersignificant shear stresses that are a function of blood flow shear rate.Frequently, there is damage to small blood vessels and capillaries. Whenthese vessels are damaged, hemostasis is triggered to stop the bleeding.Under typical circumstances, such an injury is dealt with through asequence of events commonly referred to as the “thrombus formation”.Thrombus formation is dependent upon platelet adhesion, activation andaggregation and the coagulation cascade that culminates in theconversion of soluble fibrinogen to insoluble fibrin clot. Thrombusformation at site of wound prevents extravasation of blood components.Subsequently, wound healing and clot dissolution occurs and blood vesselintegrity and flow is restored.

The term “HDL” refers to the high-density lipoproteins.

The term “LDL”, as used herein, means the low-density lipoproteins.

The term “VLDL” refers to the very low density lipoproteins.

The term “treatment” or “treating” includes the administration to asubject in need of a pharmacologically active amount of a modified LCATprotein of the invention which will inhibit, decrease or reversedevelopment of, for example, a pathological atherosclerosis,inflammatory disorder, or thrombosis-related disorder. In anotheraspect, treatment as used herein means the administration, to a subjectin need, of an amount of a compound of the invention, which, withrespect to atherosclerosis, will increase HDL cholesterol levels.“Inhibiting,” in connection with inhibiting atherosclerosis, is intendedto mean preventing, retarding, stabilizing, or reversing formation orgrowth of atheromatous plaques, inflammatory disorder, orthrombosis-related disorder. Treatment of diseases and disorders hereinis intended to also include therapeutic administration of a modifiedLCAT protein of the invention (or a pharmaceutical salt, derivative orprodrug thereof) or a pharmaceutical composition containing the modifiedLCAT protein to a subject believed to be in need of treatment fordiseases and disorders, such as, for example, inflammatory disorders,thrombosis disorders, coronary heart disease, high blood pressure, LCATdeficiency syndrome, Alzheimer's disease, corneal opacity, metabolicsyndrome, dyslipidemia, myocardial infarction, stroke, critical limbischemia, angina and the like. Treatment also encompasses administrationof the modified LCAT protein or pharmaceutical composition to subjectsnot having been diagnosed as having a need thereof, i.e., prophylacticadministration to the subject, for prevention of a condition ordisorder. Generally, the subject is initially diagnosed by a licensedphysician and/or authorized medical practitioner, and a regimen forprophylactic and/or therapeutic (acute or chronic) treatment viaadministration of the modified LCAT protein(s) or compositions of theinvention is suggested, recommended or prescribed.

The phrase “therapeutically effective amount” is the amount of thecompound of the invention that will achieve the goal of improvement indisorder severity and the frequency of incidence. The improvement indisorder severity includes, for example with respect to atherosclerosis,prevention of accumulation of cholesterol in vessel walls increasing ofblood levels of HDL cholesterol, the reversal of atherosclerosis, aswell as slowing down the progression of atherosclerosis, prevention ortreatment of inflammatory disorders, and prevention or treatment ofthrombosis-relating conditions.

As used herein, the term “subject” is intended to mean a human or othermammal, exhibiting, or at risk of developing, atherosclerosis, aninflammatory disorder or a thrombosis-related disorder. Such anindividual can have, or be at risk of developing, for example,conditions such as inflammation, thrombosis, coronary heart disease,high blood pressure, LCAT deficiency syndrome, Alzheimer's disease,corneal opacity, metabolic syndrome, dyslipidemia, myocardialinfarction, stroke, critical limb ischemia, angina and the like. Theprognostic and clinical indications of these conditions are known in theart.

II. Modified LCAT Proteins

A. Assays

Assays for determining LCAT enzyme activity, plasma stability (enzymehalf-life in the plasma) or the plasma LCAT protein levels are known inthe art. Absolute LCAT activity in the serum and endogenous cholesterolesterification rate can be determined as described, e.g., in Albers J.et al. (1986) Methods in Enzymol. 129: 763-783; Dobiasova M. et al.(1983) Adv. Lipid Res. 20: 107-194. In one aspect, LCAT activity can bedetermined by measuring the conversion of radiolabeled cholesterol tocholesterol ester after incubation of LCAT and radiolabeled LCATsubstrates containing Apo A-I. Cholesterol esterification rate (CER,nmol CE/mL per hour) can be measured by determining the rate ofconversion of labeled cholesterol to cholesteryl ester after incubationof plasma that is radiolabeled with a trace amount of radioactivecholesterol by equilibration with a [¹⁴C] cholesterol-albumin mixture at4° C. The endogenous cholesterol esterification rate (as determined withplasma LCAT activity assay) reflects not only on mass of LCAT, but alsothe nature and amount of LCAT substrate and cofactor present in theserum, and therefore provides a better measure of the therapeutic LCATactivity.

Assays for measuring LCAT stability (half-life) in the blood and plasmaLCAT protein concentration are also known in art. After administration,recombinant LCAT protein levels in the plasma can be determined by usingELISA described by J R Crowther: ELISA theory and practice, methods inmolecular Biology Volume 42). Reagents for measuring LCAT stability andprotein concentration include anti-LCAT antibodies, which arecommercially available from several vendors. Examples of use of thisassay to determine activity and/or stability of the modified LCAT aregiven below.

B. Amino Acid Modifications

Modified LCAT proteins are provided comprising an amino acidsubstitution in a wild type LCAT protein amino acid sequence. Becausethe amino acid sequence in a wild type LCAT protein is modified throughsubstitution of one or more amino acids, the modified LCAT protein is,in one aspect, a non-naturally-occurring protein. Modified LCAT proteinsare derived from any wild type LCAT protein, with exemplary wild typeLCAT proteins set out in FIG. 1A-1J.

For aspects of the invention that include treatment of human conditionsthat arise from LCAT-related disorders, the invention provides modifiedLCAT proteins wherein a human LCAT protein is modified to include one ormore amino acid substitutions, or one or more amino acid addition, andin one aspect, the wild type human LCAT amino acid sequence is set outin SEQ ID NO: 1. In discussion of specific amino acids in the human LCATprotein sequence set out in SEQ ID NO: 1, it will be understood by theworker of ordinary skill in the art that the same or similarmodification at the same or corresponding amino acid residue in otherhuman LCAT amino acid sequences (i.e., allelic variants or othernaturally-occurring LCAT sequences) or in orthologous LCAT amino acidsequences are contemplated and embraced. With respect to SEQ ID NO: 1,amino acid substitutions are contemplated at (using single letter aminoacid designations followed by position in the protein sequence, i.e.,“F1” indicates phenylalanine at position 1 in SEQ ID NO: 1: F1, W2, L3,L4, N5, V6, L7, F8, P9, P10, H11, T12, T13, P14, K15, A16, E17, L18,S19, N20, H21, T22, R23, P24, V25, I26, L27, V28, P29, G30, C31, L32,G33, N34, Q35, L36, E37, A38, K39, L40, D41, K42, P43, D44, V45, V46,N47, W48, M49, C50, Y51, R52, K53, T54, E55, D56, F57, F58, T59, I60,W61, L62, D63, L64, N65, M66, F67, L68, C69, L70, G71, V72, D73, C74,W75, I76, D77, N78, T79, R80, V81, V82, Y83, N84, R85, S86, S87, G88,L89, V90, S91, N92, A93, P94, G95, V96, Q97, I98, R99, V100, P101, G102,F103, G104, K105, T106, Y107, S108, V109, E110, Y111, L112, D113, S114,S115, K116, L117, A118, G119, Y120, L121, H122, T123, L124, V125, Q126,N127, L128, V129, N130, N131, G132, Y133, V134, R135, D136, E137, T138,V139, R140, A141, A142, P143, Y144, D145, W146, R147, L148, E149, P150,G151, Q152, Q153, E154, E155, Y156, Y157, R158, K159, L160, A161, G162,L163, V164, E165, E166, M167, H168, A169, A170, Y171, G172, K173, P174,V175, F176, L177, I178, G179, H180, S181, L182, G183, C184, L185, H186,L187, L188, Y189, F190, L191, L192, R193, Q194, P195, Q196, A197, W198,K199, D200, R201, F202, I203, D204, G205, F206, I207, S208, L209, G210,A211, P212, W213, G214, G215, S216, I217, K218, P219, M220, L221, V222,L223, A224, S225, G226, D227, N228, Q229, G230, I231, P232, I233, M234,S235, S236, I237, K238, L239, K240, E241, E242, Q243, R244, 1245, T246,T247, T248, S249, P250, W251, M252, F253, P254, S255, R256, M257, A258,W259, P260, E261, D262, H263, V264, F265, I266, S267, T268, P269, S270,F271, N272, Y273, T274, G275, R276, D277, F278, Q279, R280, F281, F282,A283, D284, L285, H286, F287, E288, E289, G290, W291, Y292, M293, W294,L295, Q296, S297, R298, D299, L300, L301, A302, G303, L304, P305, A306,P307, G308, V309, E310, V311, Y312, C313, L314, Y315, G316, V317, G318,L319, P320, T321, P322, R323, T324, Y325, I326, Y327, D328, H329, G330,F331, P332, Y333, T334, D335, P336, V337, G338, V339, L340, Y341, E342,D343, G344, D345, D346, T347, V348, A349, T350, R351, S352, T353, E354,L355, C356, G357, L358, W359, Q360, G361, R362, Q363, P364, Q365, P366,V367, H368, L369, L370, P371, L372, H373, G374, I375, Q376, H377, L378,N379, M380, V381, F382, S383, N384, L385, T386, L387, E388. H389, I390,N391, A392, I393, L394, L395, G396, A397, Y398, R399, Q400, G401, P402,P403, A404, S405, P406, T407, A408, S409, P410, E411, P412, P413, P414,P415 and/or E 416. Amino acids at one or more of these positions aresubstituted with any naturally-occurring or non-naturally-occurringamino acids. For example and without limitation, the modified LCATcomprises a C31Y substitution and a substitution at one or more of aminoacid residues F1, L4, L32, and N34. In one aspect, this secondsubstitution is F1S, F1W, L4M, L4K, N34S, L32F, and/or L32H.

In various aspects, particular substitutions are provided. For example,and without limitation, an aliphatic amino acid residue (G, A, V, L, orI) is substituted with another aliphatic, an aromatic amino acid residue(F,Y, or W) is substituted with another aromatic residue, an aliphatichydroxyl side chain residue (S or T) is replaced with another aliphatichydroxyl side chain residue, a basic residue (K, R, or H) is replacedwith another basic amino acid residue, an acidic residue (D or E) isreplaced with another acidic amino acid residue, an amide side chainresidue (N or Q) is replaced with another amide side chain residue, ahydrophobic residue (norleucine, M, A, V, L, or I) is replaced withanother hydrophobic residue, a neutral amino acid residue (C, S, T, N,or Q) is replaced with another neutral residue, a residue thatinfluences chain orientation (G or P) is replaced with another residuethat influences chain orientation, and/or a sulfur-containing side chainresidue (C or M) is replaced with another sulfur-containing side chainresidue.

In other aspects, also without limitation, conservative substitutionsare introduced into a wild type LCAT amino acid sequence.

TABLE 1 Exemplary Conservative Original Residue Substitutions A G, S R KN Q, H D E C S Q N E D G A, P H N, Q I L, V L I, V K R, Q, E M L, Y, I FM, L, Y S T T S W Y Tyr W, F Val I, L

Still other substitutions contemplated include, also without limitation,those set out in Table 2 below.

TABLE 2 Original Residue Exemplary Substitutions A V, L, I R K, Q, N N QD E C S, A Q N E D G P, A H N, Q, K, R I L, V, M, A, F, Norleucine LNorleucine, I, V, M, A, F K R, 1,4 Diamino-butyric Acid, Q, N M L, F, IF L, V, I, A, Y P A S T, A, C T S W Y, F Y W, F, T, S V I, M, L, F, A,Norleucine

C. Derivatives

In addition to modified LCAT proteins described above, it iscontemplated that other “derivatives” of modified LCAT proteins may besubstituted for a modified LCAT protein described above. Suchderivatives may improve the solubility, absorption, biological halflife, and the like of the compounds. The moieties may alternativelyeliminate or attenuate any undesirable side-effect of the compounds andthe like.

Such derivatives of modified LCAT proteins include those in which:

1. The modified LCAT proteins or some portion thereof is cyclic. Forexample, the peptide portion may be modified to contain two or morecysteine residues (e.g., in the linker), which could cyclize bydisulfide bond formation.

2. The modified LCAT protein is cross-linked or is rendered capable ofcross-linking between molecules. For example, the peptide portion may bemodified to contain one cysteine residue and thereby be able to form anintermolecular disulfide bond with a like molecule. The protein may alsobe cross-linked through its C-terminus.

3. One or more peptidyl [—C(O)NR—] linkages (bonds) is replaced by anon-peptidyl linkage. Exemplary non-peptidyl linkages are —CH₂-carbamate[—CH₂—OC(O)NR—], phosphonate, —CH₂-sulfonamide [—CH₂—S(O)₂NR—], urea[—NHC(O)NH—], —CH₂-secondary amine, and alkylated peptide [—C(O)NR₆—wherein R₆ is lower alkyl].

4. The N-terminus is derivatized. Typically, the N-terminus may beacylated or modified to a substituted amine. Exemplary N-terminalderivative groups include —NRR¹ (other than —NH₂), —NRC(O)R¹,—NRC(O)OR¹, —NRS(O)₂R¹, —NHC(O)NHR¹, succinimide, or benzyloxycarbonyl—NH—(CBZ—NH—), wherein R and R¹ are each independently hydrogen or loweralkyl with the proviso that R and R¹ are not both hydrogen and whereinthe phenyl ring may be substituted with 1 to 3 substituents selectedfrom the group consisting of C₁-C₄ alkyl, C₁-C₄ alkoxy, chloro, andbromo; to a succinimide group; to a benzyloxycarbonyl-NH—(CBZ—NH—)group; and peptides wherein the free C terminus is derivatized to—C(O)R₂ where R₂ is selected from the group consisting of lower alkoxyand —NR³R⁴ where R³ and R⁴ are independently selected from the groupconsisting of hydrogen and lower alkyl. By “lower” is meant a grouphaving from 1 to 6 carbon atoms.

5. The C-terminus is derivatized. Typically, the C-terminus isesterified or amidated. For example, one may use methods described inthe art to add (NH—CH₂—CH₂—NH₂)₂ to compounds of this invention at theC-terminus. Likewise, one may use methods described in the art to add—NH₂ to compounds of this invention at the C-terminus. ExemplaryC-terminal derivative groups include, for example, —C(O)R₂ wherein R² islower alkoxy or —NR³R⁴ wherein R³ and R⁴ are independently hydrogen orC₁-C₈ alkyl (or C₁-C₄ alkyl).

6. A disulfide bond is replaced with another, for example, more stable,cross-linking moiety (e.g., an alkylene). See, e.g., Bhatnagar et al.(1996), J. Med. Chem. 39: 3814-9; Alberts et al. (1993) Thirteenth Am.Pep. Symp., 357-9.

7. One or more individual amino acid residues is modified. Variousderivatizing agents are known to react specifically with selected sidechains or terminal residues, as described in detail below.

Additionally, modifications of individual amino acids may be introducedinto the modified LCAT amino acid sequence by reacting targeted aminoacid residues of the protein with an organic derivatizing agent that iscapable of reacting with selected side chains or terminal residues. Thefollowing are exemplary.

Lysinyl and amino terminal residues may be reacted with succinic orother carboxylic acid anhydrides. Derivatization with these agents hasthe effect of reversing the charge of the lysinyl residues. Othersuitable reagents for derivatizing alpha-amino-containing residuesinclude imidoesters such as methyl picolinimidate; pyridoxal phosphate;pyridoxal; chloroborohydride; trinitrobenzenesulfonic acid;O-methylisourea; 2,4 pentanedione; and transaminase-catalyzed reactionwith glyoxylate.

Arginyl residues may be modified by reaction with one or severalconventional reagents, among them phenylglyoxal, 2,3-butanedione,1,2-cyclohexanedione, and ninhydrin. Derivatization of arginine residuesrequires that the reaction be performed in alkaline conditions becauseof the high pKa of the guanidine functional group. Furthermore, thesereagents may react with the groups of lysine as well as the arginineguanidino group.

The specific modification of tyrosyl residues per se has been studiedextensively, with particular interest in introducing spectral labelsinto tyrosyl residues by reaction with aromatic diazonium compounds ortetranitromethane. Most commonly, N-acetylimidizole andtetranitromethane may be used to form O-acetyl tyrosyl species and3-nitro derivatives, respectively.

Carboxyl side groups (aspartyl or glutamyl) may be selectively modifiedby reaction with carbodiimides (R′—N═C═N—R′) such as1-cyclohexyl-3-(2-morpholinyl-(4-ethyl) carbodiimide or1-ethyl-3-(4-azonia-4,4-dimethylpentyl) carbodiimide. Furthermore,aspartyl and glutamyl residues may be converted to asparaginyl andglutaminyl residues by reaction with ammonium ions.

Glutaminyl and asparaginyl residues are frequently deamidated to thecorresponding glutamyl and aspartyl residues. Alternatively, theseresidues may be deamidated under mildly acidic conditions. Either formof these residues falls within the scope of this invention.

Cysteinyl residues at a position other than residue 31 can be replacedby amino acid residues or other moieties either to eliminate disulfidebonding or, conversely, to stabilize cross-linking. See, e.g., Bhatnagaret al. (1996), J. Med. Chem. 39: 3814-9.

Derivatization with bifunctional agents is useful for cross-linking thepeptides or their functional derivatives to a water-insoluble supportmatrix or to other macromolecular carriers. Commonly used cross-linkingagents include, e.g., 1,1-bis(diazoacetyl)-2-phenylethane,glutaraldehyde, N-hydroxysuccinimide esters, for example, esters with4-azidosalicylic acid, homobifunctional imidoesters, includingdisuccinimidyl esters such as 3,3′-dithiobis (succinimidylpropionate),and bifunctional maleimides such as bis-N-maleimido-1,8-octane.Derivatizing agents such asmethyl-3-[(p-azidophenyl)dithio]propioimidate yield photoactivatableintermediates that are capable of forming crosslinks in the presence oflight. Alternatively, reactive water-insoluble matrices such as cyanogenbromide-activated carbohydrates and the reactive substrates described inU.S. Pat. Nos. 3,969,287; 3,691,016; 4,195,128; 4,247,642; 4,229,537;and 4,330,440 may be employed for protein immobilization.

Other possible modifications include hydroxylation of proline andlysine, phosphorylation of hydroxyl groups of seryl or threonylresidues, oxidation of the sulfur atom in cysteine, methylation of thealpha-amino groups of lysine, arginine, and histidine side chains(Creighton, T. E., Proteins: Structure and Molecule Properties, W.H.Freeman & Co., San Francisco, pp. 79-86 (1983)), acetylation of theN-terminal amine, and, in some instances, amidation of the C-terminalcarboxyl groups.

Such derivatized moieties preferably improve one or more characteristicsincluding enzymatic activity, solubility, absorption, biological halflife, and the like of the inventive compounds. Alternatively,derivatized moieties result in compounds that have the same, oressentially the same, characteristics and/or properties of the compoundthat is not derivatized. The moieties may alternatively eliminate orattenuate any undesirable side effect of the compounds and the like.

Carbohydrate (oligosaccharide) groups may conveniently be attached tosites that are known to be glycosylation sites in proteins. Generally,O-linked oligosaccharides are attached to serine (Ser) or threonine(Thr) residues while N-linked oligosaccharides are attached toasparagine (Asn) residues when they are part of the sequenceAsn-X-Ser/Thr, where X can be any amino acid except proline. X ispreferably one of the 19 naturally occurring amino acids other thanproline. The structures of N-linked and O-linked oligosaccharides andthe sugar residues found in each type are different. One type of sugarthat is commonly found on both is N-acetylneuraminic acid (referred toas sialic acid). Sialic acid is usually the terminal residue of bothN-linked and O-linked oligosaccharides and, by virtue of its negativecharge, may confer acidic properties to the glycosylated compound. Suchsite(s) may be incorporated in the linker of the compounds of thisinvention and are preferably glycosylated by a cell during recombinantproduction of the polypeptide compounds (e.g., in mammalian cells suchas CHO, BHK, COS). However, such sites may further be glycosylated bysynthetic or semi-synthetic procedures known in the art.

Modified LCAT proteins of the present invention may be changed at theDNA level, as well. The DNA sequence of any portion of the compound maybe changed to codons more compatible with the chosen host cell. For E.coli, which is the host cell in one aspect, optimized codons are knownin the art. Codons may be substituted to eliminate restriction sites orto include silent restriction sites, which may aid in processing of theDNA in the selected host cell. The vehicle, linker and peptide DNAsequences may be modified to include any of the foregoing sequencechanges.

Another set of useful derivatives are the above-described moleculesconjugated to toxins, tracers, or radioisotopes. Such conjugation isespecially useful for molecules comprising peptide sequences that bindto tumor cells or pathogens. Such molecules may be used as therapeuticagents or as an aid to surgery (e.g., radioimmunoguided surgery or RIGS)or as diagnostic agents (e.g., radioimmunodiagnostics or RID).

As therapeutic agents, these conjugated derivatives possess a number ofadvantages. They facilitate use of toxins and radioisotopes that wouldbe toxic if administered without the specific binding provided by thepeptide sequence. They also can reduce the side-effects that attend theuse of radiation and chemotherapy by facilitating lower effective dosesof the conjugation partner.

Useful conjugation partners include:

-   -   radioisotopes, such as ⁹⁰Yttrium, ¹³¹Iodine, ²²⁵Actinium, and        ²¹³ Bismuth;    -   ricin A toxin, microbially derived toxins such as Pseudomonas        endotoxin (e.g., PE38, PE40), and the like;    -   partner molecules in capture systems (see below);    -   biotin, streptavidin (useful as either partner molecules in        capture systems or as tracers, especially for diagnostic use);        and    -   cytotoxic agents (e.g., doxorubicin).

One useful adaptation of these conjugated derivatives is use in acapture system. In such a system, the molecule of the present inventionwould comprise a benign capture molecule. This capture molecule would beable to specifically bind to a separate effector molecule comprising,for example, a toxin or radioisotope. Both the vehicle-conjugatedmolecule and the effector molecule would be administered to the patient.In such a system, the effector molecule would have a short half-lifeexcept when bound to the vehicle-conjugated capture molecule, thusminimizing any toxic side-effects. The vehicle-conjugated molecule wouldhave a relatively long half-life but would be benign and non-toxic. Thespecific binding portions of both molecules can be part of a knownspecific binding pair (e.g., biotin, streptavidin) or can result frompeptide generation methods such as those described herein.

Such conjugated derivatives may be prepared by methods known in the art.In the case of protein effector molecules (e.g., Pseudomonas endotoxin),such molecules can be expressed as fusion proteins from correlative DNAconstructs. Radioisotope conjugated derivatives may be prepared, forexample, as described for the BEXA antibody (Coulter). Derivativescomprising cytotoxic agents or microbial toxins may be prepared, forexample, as described for the BR96 antibody (Bristol-Myers Squibb).Molecules employed in capture systems may be prepared, for example, asdescribed by the patents, patent applications, and publications fromNeoRx. Molecules employed for RIGS and RID may be prepared, for example,by the patents, patent applications, and publications from NeoProbe.

D. Vehicle/Carrier Moieties

The compounds of the invention may also be covalently or noncovalentlyassociated with a carrier molecule, such as a linear polymer (e.g.,polyethylene glycol, polylysine, dextran, etc.), a branched-chainpolymer (see, for example, U.S. Pat. No. 4,289,872; U.S. Pat. No.5,229,490; WO 93/21259); a lipid; a cholesterol group (such as asteroid); or a carbohydrate or oligosaccharide. Other possible carriesinclude antibody moieties, and in particular constant regions derivedfrom an antibody. Still other possible carriers include one or morewater soluble polymer attachments such as polyoxyethylene glycol, orpolypropylene glycol as described U.S. Pat. Nos. 4,640,835, 4,496,689,4,301,144, 4,670,417, 4,791,192 and 4,179,337. Still other usefulpolymers known in the art include monomethoxy-polyethylene glycol,dextran, cellulose, or other carbohydrate based polymers, poly-(N-vinylpyrrolidone)-polyethylene glycol, propylene glycol homopolymers, apolypropylene oxide/ethylene oxide co-polymer, polyoxyethylated polyols(e.g., glycerol) and polyvinyl alcohol, as well as mixtures of thesepolymers.

1. Immunoglobulin Constant Region Vehicles/Carriers

In one aspect, a modified LCAT protein of the invention includes atleast one vehicle attached to the protein through the N-terminus,C-terminus or a side chain of one of the amino acid residues. In oneembodiment, an Fc domain is a vehicle. Thus, an Fc domain may be fusedto the N or C termini of the peptides or at both the N and C termini.Multiple vehicles, as exemplified herein, may also be used; e.g., an Fcat each terminus or an Fc at a terminus and a PEG group at the otherterminus or a side chain.

In various embodiments, the Fc component is either a native Fc or an Fcvariant. By way of example and without limitation, the Fc component isan Fc region of the human immunoglobulin IgG1 heavy chain or abiologically active fragment, derivative, or dimer thereof, see Ellison,J. W. et al., Nucleic Acids Res. 10:4071-4079 (1982). It is understood,however, that an Fc region for use in the invention may be derived froman IgG, IgA, IgM, IgE or IgD from any species. Native Fc domains aremade up of monomeric polypeptides that may be linked into dimeric ormultimeric forms by covalent (i.e., disulfide bonds) and/or non-covalentassociation. The number of intermolecular disulfide bonds betweenmonomeric subunits of native Fc molecules ranges from 1 to 4 dependingon class (e.g., IgG, IgA, IgE) or subclass (e.g., IgG1, IgG2, IgG3,IgA1, IgGA2). One example of a native Fc is a disulfide-bonded dimerresulting from papain digestion of an IgG (see Ellison et al. (1982),Nucleic Acids Res. 10: 4071-9).

In various aspects, Fc sequences contemplated include those known in theart such as, for example, Fc IgG1 (GenBank Accession No. P01857), FcIgG2 (GenBank Accession No. P01859), Fc IgG3 (GenBank Accession No.P01860), Fc IgG4 (GenBank Accession No. P01861), Fc IgA1 (GenBankAccession No. P01876), Fc IgA2 (GenBank Accession No. P01877), Fc IgD(GenBank Accession No. P01880), Fc IgM (GenBank Accession No. P01871),and Fc IgE (GenBank Accession No. P01854).

Variants, analogs or derivatives of the Fc portion may be constrictedby, for example, making various substitutions of residues or sequences.In one aspect, an Fc variant is incorporated which comprises a moleculeor sequence that is humanized from a non-human native Fc. Alternately,an Fc variant comprises a molecule or sequence that lacks one or morenative Fc sites or residues that affect or are involved in (1) disulfidebond formation, (2) incompatibility with a selected host cell (3)N-terminal heterogeneity upon expression in a selected host cell, (4)glycosylation, (5) interaction with complement, (6) binding to an Fcreceptor other than a salvage receptor, or (7) antibody-dependentcellular cytotoxicity (ADCC), each of which is described in detail inU.S. Patent Application No. 20040087778, the disclosure of which isincorporated by reference in its entirety.

Variant (or analog) Fc polypeptide moieties include any insertionvariants, wherein one or more amino acid residues supplement an Fc aminoacid sequence. Insertions may be located at either or both termini ofthe protein, or may be positioned within internal regions of the Fcamino acid sequence. Insertion variants, with additional residues ateither or both termini, can include for example, fusion proteins andproteins including amino acid tags or labels. For example, the Fcmolecule may optionally contain an N-terminal Met, especially when themolecule is expressed recombinantly in a bacterial cell such as E. coli.

In Fc deletion variants, one or more amino acid residues in an Fcpolypeptide are removed. Deletions can be effected at one or bothtermini of the Fc polypeptide, or with removal of one or more residueswithin the Fc amino acid sequence. Deletion variants, therefore, includeall fragments of an Fc polypeptide sequence.

In Fc substitution variants, one or more amino acid residues of an Fcpolypeptide are removed and replaced with alternative residues. In oneaspect, the substitutions are conservative in nature and conservativesubstitutions of this type are well known in the art. Alternatively, theinvention embraces substitutions that are also non-conservative.

For example, cysteine residues can be deleted or replaced with otheramino acids to prevent formation of some or all disulfide crosslinkingof the Fc sequences. Each cysteine residue can be removed and/orsubstituted with other amino acids, such as Ala or Ser. As anotherexample, modifications may also be made to introduce amino acidsubstitutions to (1) ablate the Fc receptor binding site; (2) ablate thecomplement (C1q) binding site; and/or to (3) ablate the antibodydependent cell-mediated cytotoxicity (ADCC) site. Such sites are knownin the art, and any known substitutions are within the scope of Fc asused herein. For example, see Molecular Immunology, Vol. 29, No. 5,633-639 (1992) with regard to ADCC sites in IgG1.

Likewise, one or more tyrosine residues can be replaced by phenylalanineresidues. In addition, other variant amino acid insertions, deletionsand/or substitutions are also contemplated and are within the scope ofthe present invention. In one aspect, these could be conservative aminoacid substitutions. Furthermore, alterations may be in the form ofaltered amino acids, such as peptidomimetics or D-amino acids.

As noted above, both native Fc and Fc variants are suitable Fc domainsfor use within the scope of this invention. A native Fc may beextensively modified to form an Fc variant provided binding to thesalvage receptor is maintained; see, for example WO 97/34631 and WO96/32478. In such Fc variants, one may remove one or more sites of anative Fc that provide structural features or functional activity notrequired by the fusion molecules of this invention. One may remove thesesites by, for example, substituting or deleting residues, insertingresidues into the site, or truncating portions containing the site. Theinserted or substituted residues may also be altered amino acids, suchas peptidomimetics or D-amino acids. Fc variants may be desirable for anumber of reasons, several of which are described below. Exemplary Fcvariants include molecules and sequences in which:

1. Sites involved in disulfide bond formation are removed. Such removalmay avoid reaction with other cysteine-containing proteins present inthe host cell used to produce the molecules of the invention. For thispurpose, the cysteine-containing segment at the N-terminus may betruncated or cysteine residues may be deleted or substituted with otheramino acids (e.g., alanyl, seryl). Even when cysteine residues areremoved, the single chain Fc domains can still form a dimeric Fc domainthat is held together non-covalently.

2. A native Fc is modified to make it more compatible with a selectedhost cell. For example, one may remove the PA sequence near theN-terminus of a typical native Fc, which may be recognized by adigestive enzyme in E. coli such as proline iminopeptidase. One may alsoadd an N-terminal methionine residue, especially when the molecule isexpressed recombinantly in a bacterial cell such as E. coli.

3. A portion of the N-terminus of a native Fc is removed to preventN-terminal heterogeneity when expressed in a selected host cell. Forthis purpose, one may delete any of the first 20 amino acid residues atthe N-terminus, particularly those at positions 1, 2, 3, 4 and 5.

4. One or more glycosylation sites are removed. Residues that aretypically glycosylated (e.g., asparagine) may confer cytolytic response.Such residues may be deleted or substituted with unglycosylated residues(e.g., alanine).

5. Sites involved in interaction with complement, such as the C1qbinding site, are removed. For example, one may delete or substitute theEKK sequence of human IgG1. Complement recruitment may not beadvantageous for the molecules of this invention and so may be avoidedwith such an Fc variant.

6. Sites are removed that affect binding to Fc receptors other than asalvage receptor. A native Fc may have sites for interaction withcertain white blood cells that are not required for the fusion moleculesof the present invention and so may be removed.

7. The ADCC site is removed. ADCC sites are known in the art; see, forexample, Molec. Immunol. 29 (5): 633-9 (1992) with regard to ADCC sitesin IgG1. These sites, as well, are not required for the fusion moleculesof the present invention and so may be removed.

8. When the native Fc is derived from a non-human antibody, the nativeFc may be humanized. Typically, to humanize a native Fc, one willsubstitute selected residues in the non-human native Fc with residuesthat are normally found in human native Fc. Techniques for antibodyhumanization are well known in the art.

It should be noted that Fc monomers will spontaneously dimerize when theappropriate cysteine residues are present, unless particular conditionsare present that prevent dimerization through disulfide bond formation.Even if the cysteine residues that normally form disulfide bonds in theFc dimer are removed or replaced by other residues, the monomeric chainswill generally form a dimer through non-covalent interactions. The term“Fc” herein is used to mean any of these forms: the native monomer, thenative dimer (disulfide bond linked), modified dimers (disulfide and/ornon-covalently linked), and modified monomers (i.e., derivatives).

Fc sequences may also be derivatized, i.e., bearing modifications otherthan insertion, deletion, or substitution of amino acid residues. In oneaspect, the modifications are covalent in nature, and include forexample, chemical bonding with polymers, lipids, other organic, andinorganic moieties. However, non-covalent modifications are alsocontemplated. Derivatives of the invention may be prepared to increasecirculating half-life, or may be designed to improve targeting capacityfor the polypeptide to desired cells, tissues, or organs.

It is also possible to use the salvage receptor binding domain of theintact Fc molecule as the Fc part of a compound of the invention, suchas described in WO 96/32478, entitled “Altered Polypeptides withIncreased Half-Life.” Additional members of the class of moleculesdesignated as Fc herein are those that are described in WO 97/34631,entitled “Immunoglobulin-Like Domains with Increased Half-Lives.”

2. Water-Soluble Polymer Vehicles

As noted above, polymer vehicles are also contemplated. Various meansfor attaching chemical moieties useful as vehicles are currentlyavailable, see, e.g., International Publication No. WO 96/11953,entitled “N-Terminally Chemically Modified Protein Compositions andMethods,” herein incorporated by reference in its entirety. This PCTpublication discloses, among other things, the selective attachment ofwater soluble polymers to the N-terminus of proteins.

Thus, the invention contemplates compounds comprising a water-solublepolymer (WSP). Suitable, clinically acceptable, WSP include withoutlimitation, PEG, polyethylene glycol propionaldehyde, copolymers ofethylene glycol/propylene glycol, monomethoxy-polyethylene glycol,carboxymethylcellulose, polyacetals, polyvinyl alcohol (PVA), polyvinylpyrrolidone, poly-1,3-dioxolane, poly-1,3,6-trioxane, ethylene/maleicanhydride copolymer, poly-β-amino acids (either homopolymers or randomcopolymers), poly(n-vinyl pyrrolidone)polyethylene glycol, propropyleneglycol homopolymers (PPG) and other polyakylene oxides, polypropyleneoxide/ethylene oxide copolymers, polyoxyethylated polyols (POG) (e.g.,glycerol) and other polyoxyethylated polyols, polyoxyethylated sorbitol,or polyoxyethylated glucose, colonic acids or other carbohydratepolymers, Ficoll or dextran and mixtures thereof. In fact, any of theforms of PEG that have been used to derivatize other proteins, such asand without limitation mono-(C1-C10) alkoxy- or aryloxy-polyethyleneglycol, are provided. Polyethylene glycol propionaldehyde may haveadvantages in manufacturing due to its stability in water.

The PEG group may be of any convenient molecular weight and may belinear or branched. The average molecular weight of PEG contemplated foruse in the invention ranges from about 2 kDa to about 100 kDa, fromabout 5 kDa to about 50 kDa, from about 5 kDa to about 10 kDa. Inanother aspect, the PEG moiety has a molecular weight from about 6 kDato about 25 kDa. PEG groups generally are attached to peptides orproteins via acylation or reductive alkylation through a reactive groupon the PEG moiety (e.g., an aldehyde, amino, thiol, or ester group) to areactive group on the target peptide or protein (e.g., an aldehyde,amino, or ester group). Using methods described herein, a mixture ofpolymer/peptide conjugate molecules can be prepared, and the advantageprovided herein is the ability to select the proportion ofpolymer/peptide conjugate to include in the mixture. Thus, if desired, amixture of peptides with various numbers of polymer moieties attached(i.e., zero, one or two) can be prepared with a predetermined proportionof polymer/protein conjugate.

A useful strategy for the PEGylation of synthetic peptides consists ofcombining, through forming a conjugate linkage in solution, a peptideand a WSP (PEG) moiety, each bearing a special functionality that ismutually reactive toward the other. The peptides can be easily preparedwith conventional solid phase synthesis. The peptides are “preactivated”with an appropriate functional group at a specific site. The precursorsare purified and fully characterized prior to reacting with the PEGmoiety. Ligation of the peptide with PEG usually takes place in aqueousphase and can be easily monitored by reverse phase analytical HPLC. ThePEGylated peptides can be easily purified by preparative HPLC andcharacterized by analytical HPLC, amino acid analysis and laserdesorption mass spectrometry.

Polysaccharide polymers are another type of WSP which may be used forprotein modification. Dextrans are polysaccharide polymers comprised ofindividual subunits of glucose predominantly linked by α1-6 linkages.The dextran itself is available in many molecular weight ranges, and isreadily available in molecular weights from about 1 kD to about 70 kD.Dextran is a suitable water soluble polymer for use in the presentinvention as a vehicle by itself or in combination with another vehicle(e.g., Fc). See, for example, WO 96/11953 and WO 96/05309. The use ofdextran conjugated to therapeutic or diagnostic immunoglobulins has beenreported; see, for example, European Patent Publication No. 0 315 456.Dextran of about 1 kD to about 20 kD is preferred when dextran is usedas a vehicle in accordance with the present invention.

The WSP moiety of the molecule may be branched or unbranched. Fortherapeutic use of the end-product preparation, the polymer ispharmaceutically acceptable. In general, a desired polymer is selectedbased on such considerations as whether the polymer conjugate will beused therapeutically, and if so, the desired dosage, circulation time,resistance to proteolysis, and other considerations. In various aspects,the average molecular weight of each WSP is between about 2 kDa andabout 100 kDa, between about 5 kDa and about 50 kDa, between about 12kDa and about 40 kDa and between about 20 kDa and about 35 kDa. In yetanother aspect the molecular weight of each polymer is between about 6kDa and about 25 kDa. The term “about” as used herein and throughout,indicates that in preparations of a water soluble polymer, somemolecules will weigh more, some less, than the stated molecular weight.Generally, the higher the molecular weight or the more branches, thehigher the polymer/protein ratio. Other sizes may be used, depending onthe desired therapeutic profile including for example, the duration ofsustained release; the effects, if any, on biological activity; the easein handling; the degree or lack of antigenicity and other known effectsof a water soluble polymer on a therapeutic protein.

The WSP should be attached to the protein with consideration given toeffects on functional or antigenic domains of the peptide or protein. Ingeneral, chemical derivitization may be performed under any suitablecondition used to react a protein with an activated polymer molecule.Activating groups which can be used to link the water soluble polymer toone or more proteins include without limitation sulfone, maleimide,sulfhydryl, thiol, triflate, tresylate, azidirine, oxirane and5-pyridyl. If attached to the peptide by reductive alkylation, thepolymer selected should have a single reactive aldehyde so that thedegree of polymerization is controlled.

3. Alternative Vehicles

Alternative vehicles include a protein, polypeptide, peptide, or smallmolecule (e.g., a peptidomimetic compound) capable of binding to asalvage receptor. For example, one could use as a vehicle a polypeptideas described in U.S. Pat. No. 5,739,277. Peptides could also be selectedby phage display for binding to the FcRn salvage receptor. Such salvagereceptor-binding compounds are also included within the meaning of“vehicle” and are within the scope of this invention. Such vehiclesshould be selected for increased half-life (e.g., by avoiding sequencesrecognized by proteases) and decreased immunogenicity (e.g., by favoringnon-immunogenic sequences, as discovered in antibody humanization).

III. Production of Modified LCAT Proteins/Methods of Making

A. Polynucleotides

The proteins described herein largely may be made in transformed hostcells using recombinant DNA techniques. To do so, a recombinant DNAmolecule coding for the peptide is prepared. Methods of preparing suchDNA molecules are well known in the art. For instance, sequences codingfor the peptides could be excised from DNA using suitable restrictionenzymes. Alternatively, the DNA molecule could be synthesized usingchemical synthesis techniques, such as the phosphoramidate method. Also,a combination of these techniques could be used.

The invention also includes a vector capable of expressing the peptidesin an appropriate host. The vector comprises the DNA molecule that codesfor the peptides operatively linked to appropriate expression controlsequences. Methods of effecting this operative linking, either before orafter the DNA molecule is inserted into the vector, are well known.Expression control sequences include promoters, activators, enhancers,operators, ribosomal binding sites, start signals, stop signals, capsignals, polyadenylation signals, and other signals involved with thecontrol of transcription or translation.

The resulting vector having the DNA molecule thereon is used totransform an appropriate host. This transformation may be performedusing methods well known in the art.

Any of a large number of available and well-known host cells may be usedin the practice of this invention. The selection of a particular host isdependent upon a number of factors recognized by the art. These include,for example, compatibility with the chosen expression vector, toxicityof the peptides encoded by the DNA molecule, rate of transformation,ease of recovery of the peptides, expression characteristics, bio-safetyand costs. A balance of these factors must be struck with theunderstanding that not all hosts may be equally effective for theexpression of a particular DNA sequence. Within these generalguidelines, useful microbial hosts include bacteria (such as E. colisp.), yeast (such as Saccharomyces sp.) and other fungi, insects,plants, mammalian (including human) cells in culture, or other hostsknown in the art.

Next, the transformed host is cultured and purified. Host cells may becultured under conventional fermentation conditions so that the desiredcompounds are expressed. Such fermentation conditions are well known inthe art. Finally, the peptides are purified from culture by methods wellknown in the art.

The modified LCAT proteins may also be made by synthetic methods. Forexample, solid phase synthesis techniques may be used. Suitabletechniques are well known in the art, and include those described inMerrifield (1973), Chem. Polypeptides, pp. 335-61 (Katsoyannis andPanayotis eds.); Merrifield (1963), J. Am. Chem. Soc. 85: 2149; Davis etal. (1985), Biochem. Intl. 10: 394-414; Stewart and Young (1969), SolidPhase Peptide Synthesis; U.S. Pat. No. 3,941,763; Finn et al. (1976),The Proteins (3rd ed.) 2: 105-253; and Erickson et al. (1976), TheProteins (3rd ed.) 2: 257-527. Solid phase synthesis is a contemplatedtechnique of making individual peptides since it is the mostcost-effective method of making small peptides.

B. Vectors

For recombinant protein expression, the invention provides a vectorencoding a modified LCAT protein which can be expressed in anappropriate host. Such a vector comprises a polynucleotide that encodesa modified LCAT protein, with or without a vehicle modification,operatively linked to appropriate expression control sequences. Methodsof effecting operative linking, either before or after the DNA moleculeis inserted into the vector, are well known in the art. Expressioncontrol sequences include promoters, activators, enhancers, operators,ribosomal binding sites, start signals, stop signals, cap signals,polyadenylation signals, and/or other signals involved with the controlof transcription or translation. The worker of skill in the art willappreciate that various combinations of these control sequences can beutilized, depending on, for example, the choice of host cell in whichthe modified LCAT protein is to be expressed. The resulting vector istransformed into an appropriate host using methods well known in theart.

C. Host Cells

Any of a large number of available and well-known host cells is used toexpress a modified LCAT protein. Selection of a host is dependent upon anumber of factors including, for example and without limitation,compatibility with the chosen expression vector, toxicity of theexpressed modified LCAT protein encoded by a transformed polynucleotide,rate of transformation, ease of recovery of the expressed modified LCATprotein, expression characteristics, degree and type of glycosylation,if desired, bio-safety and costs. A balance of these factors must bestruck with the understanding that not all host cells may be equallyeffective for the expression of a particular modified LCAT protein.Depending upon the host cell employed, the modified LCAT expressionproduct may be glycosylated with mammalian or other eukaryoticcarbohydrates, or it may be non-glycosylated. The modified LCATexpression product may also include an initial methionine amino acidresidue (at amino acid residue position −1) if expressed in, forexample, a bacterial host cell. Within these general guidelines, usefulhost cells include bacteria, yeast and other fungi, insects, plants,mammalian (including human) cells in culture, or other host cells knownin the art. Host cells are cultured under conventional fermentationconditions well known in the art to permit expression of the desiredcompounds and the modified LCAT expression product is purified usingtechniques also known in the art.

Depending on the host cell utilized to express modified LCAT protein,carbohydrate (oligosaccharide) groups may conveniently be attached tosites that are known to be glycosylation sites in proteins. Generally,O-linked oligosaccharides are attached to serine (Ser) or threonine(Thr) residues while N-linked oligosaccharides are attached toasparagine (Asn) residues when they are part of the sequenceAsn-X-Ser/Thr, where X can be any amino acid except proline. X ispreferably one of the 19 naturally occurring amino acids not countingproline. The structures of N-linked and O-linked oligosaccharides andthe sugar residues found in each type are different. One type of sugarthat is commonly found on both is N-acetylneuraminic acid (referred toas sialic acid). Sialic acid is usually the terminal residue of bothN-linked and O-linked oligosaccharides and, by virtue of its negativecharge, may confer acidic properties to the glycosylated compound. Suchsite(s) may be incorporated in the linker of the compounds of thisinvention and are preferably glycosylated by a cell during recombinantproduction of the polypeptide compounds (e.g., in mammalian cells suchas CHO, BHK, COS). However, such sites may further be glycosylated bysynthetic or semi-synthetic procedures known in the art.

D. Vehicle modification of a modified LCAT protein

Depending on the method of WSP attachment chosen, the proportion of WSPmolecules attached to the target protein molecule will vary, as willtheir concentrations in the reaction mixture. In general, the optimumratio (in terms of efficiency of reaction in that there is no excessunreacted protein or polymer) is determined by the molecular weight ofthe WSP selected. In addition, when using methods that involvenon-specific attachment and later purification of a desired species, theratio may depend on the number of reactive groups (typically aminogroups) available.

In general, a WSP is added to a modified LCAT protein via acylation,reductive alkylation, Michael addition, thiol alkylation or otherchemoselective conjugation/ligation methods through a reactive group onthe WSP (i.e., an aldehydes, amino, ester, thiol, α-haloacetyl,maleimodo or hydrazine group) to a reactive group on the target.

Thus, a process for preparing conjugation derivatives is alsocontemplated. Thus, one aspect of this invention is a process comprisingpreparing a modified LCAT agent comprising at least one vehicle by anymethod described herein or otherwise known in the art. By way of exampleand without limitation, a reductive alkylation chemical modificationprocedure method may be utilized. An alternative method for WSPmodification is described in Francis et al., in: Stability of proteinpharmaceuticals: in vivo pathways of degradation and strategies forprotein stabilization (Eds. Ahern., T. and Manning, M. C.) Plenum, N.Y.,1991, is used. In still another aspect, the method described in Delgadoet al., “Coupling of PEG to Protein By Activation With Tresyl Chloride,Applications In Immunoaffinity Cell Preparation”, In: Fisher et al.,eds., Separations Using Aqueous Phase Systems, Applications In CellBiology and Biotechnology, Plenum Press, N.Y., N.Y., 1989 pp. 211-213,which involves the use of tresyl chloride, which results in no linkagegroup between the WSP moiety and the modified LCAT protein. Thisalternative method, however, may be difficult to use to producetherapeutic products as the use of tresyl chloride may produce toxicby-products. In other aspects, attachment of a WSP is effected throughuse of N-hydroxy succinimidyl esters of carboxymethyl methoxypolyethylene glycol, as well known in the art.

1. Reductive Alkylation

In one aspect, covalent attachment of a WSP to a modified LCAT proteinis carried out by reductive alkylation chemical modification proceduresas provided herein to selectively modify the N-terminal α-amino group,and testing the resultant product for the desired biologicalcharacteristic, such as the biological activity assays provided herein.

Reductive alkylation for attachment of a WSP to a protein or peptideexploits differential reactivity of different types of primary aminogroups (e.g., lysine versus the N-terminal) available for derivitizationin a particular protein. Under the appropriate reaction conditions,substantially selective derivitization of the protein at the N-terminuswith a carbonyl group containing polymer is achieved.

Using reductive alkylation, the reducing agent should be stable inaqueous solution and preferably be able to reduce only the Schiff baseformed in the initial process of reductive alkylation. Reducing agentsare selected from, and without limitation, sodium borohydride, sodiumcyanoborohydride, dimethylamine borate, trimethylamine borate andpyridine borate.

The reaction pH affects the ratio of polymer to protein to be used. Ingeneral, if the reaction pH is lower than the pKa of a target reactivegroup, a larger excess of polymer to protein will be desired. If the pHis higher than the target pKa, the polymer:protein ratio need not be aslarge (i.e., more reactive groups are available, so fewer polymermolecules are needed).

Accordingly, the reaction is performed in one aspect at a pH whichallows one to take advantage of the pKa differences between the ε-aminogroups of the lysine residues and that of the α-amino group of theN-terminal residue of the protein. By such selective derivitization,attachment of a water soluble polymer to a protein is controlled; theconjugation with the polymer takes place predominantly at the N-terminusof the protein and no significant modification of other reactive groups,such as the lysine side chain amino groups, occurs.

In one aspect, therefore, methods are provided for covalent attachmentof a WSP to a target modified LCAT protein which provide a substantiallyhomogenous preparation of WSP/protein conjugate molecules, in theabsence of further extensive purification as is required using otherchemical modification chemistries. More specifically, if polyethyleneglycol is used, methods described allow for production of anN-terminally PEGylated protein lacking possibly antigenic linkagegroups, i.e., the polyethylene glycol moiety is directly coupled to theprotein moiety without potentially toxic by-products.

E. Purification of a WSP-Modified Compound

The method of obtaining a substantially homogeneous WSP-LCAT proteinpreparation is, in one aspect, by purification of a predominantly singlespecies of modified LCAT having an attached WSP moiety from a mixture ofmodified LCAT species having a number of WSP attachments at variouslocations in the modified LCAT protein sequence. By way of example, asubstantially homogeneous modified LCAT species is first separated byion exchange chromatography to obtain material having a chargecharacteristic of a single species (even though other species having thesame apparent charge may be present), and then the desired species isseparated using size exclusion chromatography. Other methods arereported and contemplated by the invention, includes for example, WO90/04606, which describes a process for fractionating a mixture ofPEG-protein adducts comprising partitioning the PEG/protein adducts in aPEG-containing aqueous biphasic system. Such a system of separation canbe modified for use with modified LCAT proteins having other (i.e.,non-PEG) attachments.

Thus, one aspect of the present invention is a method for preparing aWSP-modified LCAT conjugate comprised of (a) reacting a modified LCATprotein having more than one amino group with a water soluble polymermoiety under reducing alkylation conditions, at a pH suitable toselectively activate the α-amino group at the amino terminus of theprotein moiety so that said water soluble polymer selectively attachesto said α-amino group; and (b) obtaining the reaction product.Optionally, and particularly for a therapeutic product, the reactionproducts are separated from unreacted moieties.

IV. Pharmaceutical Compositions Comprising Modified LCAT and Methods ofAdministration

While it may be possible to administer compounds of the invention alone,in the methods described, the compound administered is generally presentas an active ingredient in a desired dosage unit formulation, such aspharmaceutically acceptable composition containing conventionalpharmaceutically acceptable carriers. Thus, in another aspect of theinvention, there is provided a pharmaceutical composition comprising acompound of this invention in combination with a pharmaceuticallyacceptable carrier. Acceptable pharmaceutical carriers generally includediluents, excipients, adjuvants and the like as described herein.

A pharmaceutical composition of the invention may comprise an effectiveamount of a compound of the invention or an effective dosage amount of acompound of the invention. An effective dosage amount of a compound ofthe invention includes an amount less than, equal to, or greater than aneffective amount of the compound. For example, a pharmaceuticalcomposition in which two or more unit dosages, such as in tablets,capsules and the like, are required to administer an effective amount ofthe compound, or alternatively, a multi-dose pharmaceutical composition,such as powders, liquids and the like, in which an effective amount ofthe compound may be administered by administering a portion of thecomposition. “Unit dosage” is defined as a discrete amount of atherapeutic composition dispersed in a suitable carrier. Those ofordinary skill in the art will readily optimize effective dosages andadministration regimens as determined by good medical practice and theclinical condition of the individual patient.

The pharmaceutical compositions may generally be prepared by mixing oneor more modified LCAT proteins with one or more pharmaceuticallyacceptable carriers, excipients, binders, adjuvants, diluents,preservatives, solubilizers, emulsifiers and the like, to form a desiredadministrable formulation to treat or ameliorate a variety of diseases.Such compositions include diluents of various buffer content (e.g.,Tris-HCl, acetate, phosphate), pH and ionic strength; additives such asdetergents and solubilizing agents (e.g., Tween 80, Polysorbate 80),anti-oxidants (e.g., ascorbic acid, sodium metabisulfite), preservatives(e.g., Thimersol, benzyl alcohol) and bulking substances (e.g., lactose,mannitol); incorporation of the material into particulate preparationsof polymeric compounds such as polylactic acid, polyglycolic acid, etc.or into liposomes. Hyaluronic acid may also be used, and this may havethe effect of promoting sustained duration in the circulation. Suchcompositions may influence the physical state, stability, rate of invivo release, and rate of in vivo clearance of the present proteins andderivatives. See, e.g., Remington's Pharmaceutical Sciences, 18th Ed.(1990, Mack Publishing Co., Easton, Pa. 18042) pages 1435-1712 which areherein incorporated by reference. The compositions may be prepared inliquid form, or may be in dried powder, such as lyophilized form.Implantable sustained release formulations are also contemplated, as aretransdermal formulations.

The pharmaceutical compositions may be subjected to conventionalpharmaceutical operations such as sterilization and/or may containconventional adjuvants, such as preservatives, stabilizers, wettingagents, emulsifiers, buffers etc. The pharmaceutically active compoundsof this invention can be processed in accordance with conventionalmethods of pharmacy to produce medicinal agents for administration topatients, including humans and other mammals.

Pharmaceutical compositions can be manufactured by methods well known inthe art such as conventional granulating, mixing, dissolving,encapsulating, lyophilizing, emulsifying or levigating processes, amongothers. The compositions can be in the form of, for example, granules,powders, tablets, capsules, syrup, suppositories, injections, emulsions,elixirs, suspensions or solutions. The instant compositions can beformulated for various routes of administration, for example, by oraladministration, by transmucosal administration (including pulmonary andnasal administration), parenteral administration (including subcutaneousadministration), transdermal (topical) administration or by rectaladministration, as well as intrathecal, intravenous, intramuscular,intraperitoneal, intranasal, intraocular or intraventricular injection.The compound or compounds of the instant invention can also beadministered in a local rather than a systemic fashion, such asinjection as a sustained release formulation.

Besides those representative dosage forms described herein,pharmaceutically acceptable excipients and carriers are generally knownto those skilled in the art and are thus included in the instantinvention. Such excipients and carriers are described, for example, in“Remingtons Pharmaceutical Sciences” Mack Pub. Co., New Jersey (2000);and “Pharmaceutics The Science of Dosage Form Design, 2^(nd) Ed.(Aulton, ed.) Churchill Livingstone (2002). The following dosage formsare given by way of example and should not be construed as limiting theinvention.

A. Oral Administration

For oral, buccal, and sublingual administration, powders, suspensions,granules, tablets, pills, capsules, gelcaps, troches or lozenges,cachets, pellets and caplets are acceptable as solid dosage (and unitdosage) forms and are described generally in Chapter 89 of Remington'sPharmaceutical Sciences (1990), 18th Ed., Mack Publishing Co. Easton Pa.18042. Solid dosage forms also include liposomal or proteinoidencapsulation (for example, proteinoid microspheres reported in U.S.Pat. No. 4,925,673). Liposomal encapsulation may be used and theliposomes may be derivatized with various polymers (e.g., U.S. Pat. No.5,013,556). A description of possible solid dosage forms for thetherapeutic is given in Chapter 10 of Marshall, K., Modern Pharmaceutics(1979), edited by G. S. Banker and C. T. Rhodes. In general, theformulation includes the modified LCAT protein, and inert ingredientswhich allow for protection against the stomach environment, and releaseof the biologically active material in the intestine.

If necessary, the compounds are chemically modified to enhancebioefficacy of oral delivery. Generally, the chemical modificationcontemplated is the attachment of at least one moiety to the compoundmolecule itself, where said moiety permits (a) inhibition ofproteolysis; and (b) uptake into the blood stream from the stomach orintestine. Also desired is the increase in overall stability of thecompound and increase in circulation time in the body. Moieties usefulas covalently attached vehicles in this invention may also be used forthis purpose. Examples of such moieties include: PEG, copolymers ofethylene glycol and propylene glycol, carboxymethyl cellulose, dextran,polyvinyl alcohol, polyvinyl pyrrolidone and polyproline as well asother moieties described herein. See also, for example, Abuchowski andDavis, Soluble Polymer-Enzyme Adducts, Enzymes as Drugs (1981),Hocenberg and Roberts, eds., Wiley-Interscience, New York, N.Y., pp367-83; Newmark, et al. (1982), J. Appl. Biochem. 4: 185-9. Otherpolymers that could be used are poly-1,3-dioxolane andpoly-1,3,6-tioxocane. In one aspect, PEG moieties are provided forpharmaceutical usage, as indicated above.

For oral delivery dosage forms, it is also possible to use a salt of amodified aliphatic amino acid, such as sodiumN-(8-[2-hydroxybenzoyl]amino) caprylate (SNAC), as a carrier to enhanceabsorption of the therapeutic compounds of this invention. The clinicalefficacy of a heparin formulation using SNAC has been demonstrated in aPhase II trial conducted by Emisphere Technologies. See U.S. Pat. No.5,792,451, “Oral drug delivery composition and methods”.

The compounds of this invention can be included in the formulation asfine multiparticulates in the form of granules or pellets of particlesize about 1 mm. The formulation of the material for capsuleadministration could also be as a powder, lightly compressed plugs oreven as tablets. The therapeutic could be prepared by compression.

Oral pharmaceutical compositions contemplated can be prepared, forexample, by mixing one or more compounds of the instant invention withat least one additive or excipient such as a starch or other additiveand tableted, encapsulated or made into other desirable forms forconventional administration. Suitable additives or excipients aresucrose, lactose, cellulose sugar, mannitol, maltitol, dextran,sorbitol, starch, agar, alginates, chitins, chitosans, pectins,tragacanth gum, gum arabic, gelatins, collagens, casein, albumin,synthetic or semi-synthetic polymers or glycerides, methyl cellulose,hydroxypropylmethyl-cellulose, and/or polyvinylpyrrolidone. Optionally,oral dosage forms can contain other ingredients to aid inadministration, such as an inactive diluent, or lubricants such asmagnesium stearate, or preservatives such as paraben or sorbic acid, oranti-oxidants such as ascorbic acid, tocopherol or cysteine, adisintegrating agent, binders, thickeners, buffers, sweeteners,flavoring agents or perfuming agents. Additionally, dyestuffs orpigments may be added for identification. Tablets and pills may befurther treated with suitable coating materials known in the art.

Liquid dosage forms for oral administration may be in the form ofpharmaceutically acceptable emulsions, syrups, elixirs, suspensions,slurries and solutions, which may contain an inactive diluent, such aswater. Pharmaceutical formulations may be prepared as liquid suspensionsor solutions using a sterile liquid, such as, but not limited to, anoil, water, an alcohol, and combinations of these. Pharmaceuticallysuitable surfactants, suspending agents, emulsifying agents, and thelike may be added for oral or parenteral administration.

More specifically, various aspects of oral pharmaceutical compositionsinclude one or more of the following additives.

Colorants and flavoring agents may all be included. For example, theprotein (or derivative) may be formulated (such as by liposome ormicrosphere encapsulation) and then further contained within an edibleproduct, such as a refrigerated beverage containing colorants andflavoring agents.

One may dilute or increase the volume of the compound of the inventionwith an inert material. These diluents could include carbohydrates,especially mannitol, lactose, anhydrous lactose, cellulose, sucrose,modified dextrans and starch. Certain inorganic salts may also be usedas fillers including calcium triphosphate, magnesium carbonate andsodium chloride. Some commercially available diluents are Fast-Flo,Emdex, STA-Rx 1500, Emcompress and Avicell.

Disintegrants may be included in the formulation of the therapeutic intoa solid dosage form. Materials used as disintegrants include but are notlimited to starch including the commercial disintegrant based on starch,Explotab. Sodium starch glycolate, Amberlite, sodiumcarboxymethylcellulose, ultramylopectin, sodium alginate, gelatin,orange peel, acid carboxymethyl cellulose, natural sponge and bentonitemay all be used. Another form of the disintegrants are the insolublecationic exchange resins. Powdered gums may be used as disintegrants andas binders and these can include powdered gums such as agar, Karaya ortragacanth. Alginic acid and its sodium salt are also useful asdisintegrants.

Binders may be used to hold the therapeutic agent together to form ahard tablet and include materials from natural products such as acacia,tragacanth, starch and gelatin. Others include methyl cellulose (MC),ethyl cellulose (EC) and carboxymethyl cellulose (CMC). Polyvinylpyrrolidone (PVP) and hydroxypropylmethyl cellulose (HPMC) could both beused in alcoholic solutions to granulate the therapeutic.

An antifrictional agent may be included in the formulation of thetherapeutic to prevent sticking during the formulation process.Lubricants may be used as a layer between the therapeutic and the diewall, and these can include but are not limited to stearic acidincluding its magnesium and calcium salts, polytetrafluoroethylene(PTFE), liquid paraffin, vegetable oils and waxes. Soluble lubricantsmay also be used such as sodium lauryl sulfate, magnesium laurylsulfate, polyethylene glycol of various molecular weights, Carbowax 4000and 6000.

Glidants that might improve the flow properties of the drug duringformulation and to aid rearrangement during compression might be added.The glidants may include starch, talc, pyrogenic silica and hydratedsilicoaluminate.

To aid dissolution of the compound of this invention into the aqueousenvironment a surfactant might be added as a wetting agent. Surfactantsmay include anionic detergents such as sodium lauryl sulfate, dioctylsodium sulfosuccinate and dioctyl sodium sulfonate. Cationic detergentsmight be used and could include benzalkonium chloride or benzethoniumchloride. The list of potential nonionic detergents that could beincluded in the formulation as surfactants are lauromacrogol 400,polyoxyl 40 stearate, polyoxyethylene hydrogenated castor oil 10, 50 and60, glycerol monostearate, polysorbate 40, 60, 65 and 80, sucrose fattyacid ester, methyl cellulose and carboxymethyl cellulose. Thesesurfactants could be present in the formulation of the protein orderivative either alone or as a mixture in different ratios.

Additives may also be included in the formulation to enhance uptake ofthe compound. Additives potentially having this property are forinstance the fatty acids oleic acid, linoleic acid and linolenic acid.

Controlled release formulation may be desirable. The compound of thisinvention could be incorporated into an inert matrix which permitsrelease by either diffusion or leaching mechanisms e.g., gums. Slowlydegenerating matrices may also be incorporated into the formulation,e.g., alginates, polysaccharides. Another form of a controlled releaseof the compounds of this invention is by a method based on the Orostherapeutic system (Alza Corp.), i.e., the drug is enclosed in asemipermeable membrane which allows water to enter and push drug outthrough a single small opening due to osmotic effects. Some entericcoatings also have a delayed release effect.

Other coatings may be used for the formulation. These include a varietyof sugars which could be applied in a coating pan. The therapeutic agentcould also be given in a film coated tablet and the materials used inthis instance are divided into 2 groups. The first are the nonentericmaterials and include methyl cellulose, ethyl cellulose, hydroxyethylcellulose, methylhydroxy-ethyl cellulose, hydroxypropyl cellulose,hydroxypropyl-methyl cellulose, sodium carboxy-methyl cellulose,providone and the polyethylene glycols. The second group consists of theenteric materials that are commonly esters of phthalic acid.

A mix of materials might be used to provide the optimum film coating.Film coating may be carried out in a pan coater or in a fluidized bed orby compression coating.

B. Pulmonary Delivery Forms

Also contemplated herein is pulmonary delivery of the present protein(or derivatives thereof). The protein (or derivative) is delivered tothe lungs of a mammal while inhaling and traverses across the lungepithelial lining to the blood stream. Other reports of this includeAdjei et al., Pharma. Res. (1990) 7: 565-9; Adjei et al. (1990),Internatl. J. Pharmaceutics 63: 135-44 (leuprolide acetate); Braquet etal. (1989), J. Cardiovasc. Pharmacol. 13 (suppl.5): s.143-146(endothelin-1); Hubbard et al. (1989), Annals Int. Med. 3: 206-12(α1-antitrypsin); Smith et al. (1989), J. Clin. Invest. 84: 1145-6(α1-proteinase); Oswein et al. (March 1990), “Aerosolization ofProteins” Proc. Symp. Resp. Drug Delivery II, Keystone, Colorado(recombinant human growth hormone); Debs et al. (1988), J. Immunol. 140:3482-8 (interferon-γ and tumor necrosis factor α) and Platz et al., U.S.Pat. No. 5,284,656 (granulocyte colony stimulating factor).

Contemplated for use in the practice of this invention are a wide rangeof mechanical devices designed for pulmonary delivery of therapeuticproducts, including but not limited to nebulizers, metered doseinhalers, and powder inhalers, all of which are familiar to thoseskilled in the art. Some specific examples of commercially availabledevices suitable for the practice of this invention are the Ultraventnebulizer, manufactured by Mallinckrodt, Inc., St. Louis, Mo.; the AcornII nebulizer, manufactured by Marquest Medical Products, Englewood,Colo.; the Ventolin metered dose inhaler, manufactured by Glaxo Inc.,Research Triangle Park, N.C.; and the Spinhaler powder inhaler,manufactured by Fisons Corp., Bedford, Mass.

All such devices require the use of formulations suitable for thedispensing of the inventive compound. Typically, each formulation isspecific to the type of device employed and may involve the use of anappropriate propellant material, in addition to diluents, adjuvantsand/or carriers useful in therapy.

The inventive compound should most advantageously be prepared inparticulate form with an average particle size of less than 10 μm (ormicrons), most preferably 0.5 to 5 μm, for most effective delivery tothe distal lung.

Pharmaceutically acceptable carriers for pulmonary delivery includecarbohydrates such as trehalose, mannitol, xylitol, sucrose, lactose,and sorbitol. Other ingredients for use in formulations may includeDPPC, DOPE, DSPC and DOPC. Natural or synthetic surfactants may be used.PEG may be used (even apart from its use in derivatizing the protein oranalog). Dextrans, such as cyclodextran, may be used. Bile salts andother related enhancers may be used. Cellulose and cellulose derivativesmay be used. Amino acids may be used, such as use in a bufferformulation.

Also, the use of liposomes, microcapsules or microspheres, inclusioncomplexes, or other types of carriers is contemplated.

Formulations suitable for use with a nebulizer, either jet orultrasonic, will typically comprise the inventive compound dissolved inwater at a concentration of about 0.1 ulations may be a spray or aerosolcontaining an appropriate solvent and optionally other compounds suchas, but not limited to, stabilizers, antimicrobial agents, antioxidants,pH modifiers, surfactants, bioavailability modifiers and combinations ofthese. A propellant for an aerosol formulation may include compressedair, nitrogen, carbon dioxide, or a hydrocarbon based low boilingsolvent. The compound or compounds of the instant invention areconveniently delivered in the form of an aerosol spray presentation froma nebulizer or the like.

D. Parenteral Administration

Injectable dosage forms for parenteral administration generally includeaqueous suspensions or oil suspensions, which may be prepared using asuitable dispersant or wetting agent and a suspending agent. Injectableforms may be in solution phase or a powder suitable for reconstitutionas a solution. Both are prepared with a solvent or diluent. Acceptablesolvents or vehicles include sterilized water, Ringer's solution, or anisotonic aqueous saline solution. Alternatively, sterile oils may beemployed as solvents or suspending agents. Typically, the oil or fattyacid is non-volatile, including natural or synthetic oils, fatty acids,mono-, di- or tri-glycerides. For injection, the formulations mayoptionally contain stabilizers, pH modifiers, surfactants,bioavailability modifiers and combinations of these. The compounds maybe formulated for parenteral administration by injection such as bybolus injection or continuous infusion. A unit dosage form for injectionmay be in ampoules or in multi-dose containers.

E. Rectal Administration

For rectal administration, the pharmaceutical formulations may be in theform of a suppository, an ointment, an enema, a tablet or a cream forrelease of compound in the intestines, sigmoid flexure and/or rectum.Rectal suppositories are prepared by mixing one or more compounds of theinstant invention, or pharmaceutically acceptable salts or tautomers ofthe compound, with acceptable vehicles, for example, cocoa butter orpolyethylene glycol, which is solid phase at room temperature but liquidphase at those temperatures suitable to release a drug inside the body,such as in the rectum. Various other agents and additives may be used inthe preparation of suppositories as is well known to those of skill inthe art.

F. Pharmaceutical Formulations and Dosages

The formulations of the invention may be designed to be short-acting,fast-releasing, long-acting, and sustained-releasing as described below.Thus, the pharmaceutical formulations may also be formulated forcontrolled release or for slow release. The instant compositions mayalso comprise, for example, micelles or liposomes, or some otherencapsulated form, or may be administered in an extended release form toprovide a prolonged storage and/or delivery effect. Therefore, thepharmaceutical formulations may be compressed into pellets or cylindersand implanted intramuscularly or subcutaneously as depot injections oras implants such as stents. Such implants may employ known inertmaterials such as silicones and biodegradable polymers.

Specific dosages may be adjusted depending on conditions of disease, theage, body weight, general health conditions, sex, and diet of thesubject, dose intervals, administration routes, excretion rate, andcombinations of drugs. Any of the above dosage forms containingeffective amounts are well within the bounds of routine experimentationand therefore, well within the scope of the instant invention.

A therapeutically effective dose may vary depending upon the route ofadministration and dosage form. Typically, the compound or compounds ofthe instant invention are selected to provide a formulation thatexhibits a high therapeutic index. The therapeutic index is the doseratio between toxic and therapeutic effects which can be expressed asthe ratio between LD₅₀ and ED₅₀. The LD₅₀ is the dose lethal to 50% ofthe population and the ED₅₀ is the dose therapeutically effective in 50%of the population. The LD₅₀ and ED₅₀ are determined by standardpharmaceutical procedures in animal cell cultures or experimentalanimals.

The dosage regimen for treating LCAT-mediated diseases and otherdisorders described herein with a modified LCAT protein and/orcompositions is based on a variety of factors, including the type ofdisease, the age, weight, sex, medical condition of the patient, theseverity of the condition, the route of administration, and theparticular compound employed. Thus, the dosage regimen may vary widely,but can be determined routinely using standard methods. Dosage levels ofthe order from about 0.01 mg to 30 mg per kilogram of body weight perday, for example from about 0.1 mg to 10 mg/kg, or from about 0.25 mg to1 mg/kg are useful for all methods of use disclosed herein. Generally,the daily regimen should be in the range of 0.1-1000 micrograms of thecompound per kilogram of body weight, preferably 0.1-150 micrograms perkilogram.

1. Oral Dosages

For oral administration, the pharmaceutical composition may be in theform of, for example, a capsule, a tablet, a suspension, or liquid. Thepharmaceutical composition can be made in the form of a dosage unitcontaining a given amount of the active ingredient. For example, thesemay contain an amount of active ingredient from about 1 to 2000 mg, forexample from about 1 to 500 mg, or from about 5 to 150 mg, or from 10 to100 mg. A suitable daily dose for a human or other mammal may varywidely depending on the condition of the patient and other factors, but,once again, can be determined using routine methods.

2. Injectable Dosages

The active ingredient may also be administered by injection as acomposition with suitable carriers including saline, dextrose, or water.The daily parenteral dosage regimen will be from about 0.1 to about 30mg/kg of total body weight, such as from about 0.1 to about 10 mg/kg, orfrom about 0.25 mg to 1 mg/kg.

3. Topical Dosages

Formulations suitable for topical administration include liquid orsemi-liquid preparations suitable for penetration through the skin(e.g., liniments, lotions, ointments, creams, or pastes) and dropssuitable for administration to the eye, ear, or nose.

A suitable topical dose of active ingredient of a compound of theinvention is 0.1 mg to 150 mg administered one to four, for example oneor two times daily. For topical administration, the active ingredientmay comprise from 0.001% to 10% w/w, e.g., from 1% to 2% by weight ofthe formulation, although it may comprise as much as 10% w/w, buttypically not more than 5% w/w. In one aspect, the concentration is from0.1% to 1% of the formulation.

G. Administration Regimens

Administration of the compositions can be systemic or local, and maycomprise a single site injection or infusion of atherapeutically-effective amount of the modified LCAT proteincomposition. Any route known to those of skill in the art for theadministration of a therapeutic composition of the invention iscontemplated including, for example, intravenous, intramuscular,subcutaneous or a catheter for long-term administration. Alternatively,it is contemplated that the therapeutic composition may be delivered tothe patient at multiple sites. The multiple administrations may berendered simultaneously or may be administered over a period of time. Incertain cases, it may be beneficial to provide a continuous flow of thetherapeutic composition. Additional therapy may be administered on aperiod basis, for example, daily, weekly, or monthly. In certainembodiments, the modified LCAT polypeptide is provided locally to thesite of reperfusion.

V. Methods of Treatment

A. Atherosclerosis, Cardiovascular Disease or an Associated Disease

In one aspect, the methods of treatment of the invention aretherapeutic, and compounds and compositions of the invention areadministered to a subject already suffering from atherosclerosis,cardiovascular disease or an associated disease. In another aspect,methods of treatment are prophylactic and compounds and compositions areadministered to those subjects at risk for developing atherosclerosis.To determine whether a subject is at risk of, for exampleatherosclerosis, an atherogenic lipoprotein profile can be assessed. Forexample, a ratio of serum cholesterol to HDLs of 5:1 or above indicatesa higher than average risk of developing atherosclerosis. Other factorsinclude a serum cholesterol level of 240 mg/dL or above, an HDL level 35mg/dL or below, or an LDL level 190 mg/dL or above, a plasma LCATprotein level lower than normal (<5 μg/ml), and a decreased plasmacholesterol esterification rate (<60 nmol/ml/hr).

The amount of modified LCAT protein effective to decrease accumulationof cholesterol depends on several factors, including the species, themanner of administration, the general health of the subject, the desiredresult (e.g., prophylaxis or therapeutic treatment) and the judgment ofthe prescribing physician. For example, the practitioner may decide whatrisk levels for heart disease indicate prophylactic treatment, and whattarget level of the modified LCAT protein is indicated for the treatmentof a person already suffering from atherosclerosis.

In humans, the normal cholesterol esterification rate ranges from about60 nmol/ml/hr to about 130 nmol/mL per hour. The effective treatment ofatherosclerosis in humans can involve administration of the compositionsof the invention to achieve a cholesterol esterification rate of about200 nmol/ml/hr.

The invention provides methods for the treatment, prevention, ormanagement of a cardiovascular disease. As used herein, the term“cardiovascular diseases” refers to diseases of the heart andcirculatory system. Cardiovascular diseases which the compositions ofthe present invention are useful for preventing or treating include butare not limited to arteriosclerosis; atherosclerosis; stroke; ischemia;endothelium dysfunctions, in particular those dysfunctions affectingblood vessel elasticity; peripheral vascular disease; coronary heartdisease; myocardial infarction, cerebral infarction and restenosis,thrombosis, high blood pressure and angina. In one aspect, the inventionincludes methods of administering the compounds and compositions of theinvention for chronic treatment. In another aspect, the inventioncontemplates acute treatment.

Other diseases which the compositions of the present invention areuseful for preventing or treating include LCAT deficiency syndrome,Alzheimer's disease, corneal opacity, metabolic syndrome, dyslipidemia,myocardial infarction, stroke, critical limb ischemia.

B. Inflammatory Conditions

Methods, compounds and compositions of the invention are useful insuppressing inflammatory cell activation. The term “inflammatory cellactivation,” as used herein, means the induction by a stimulus(including, but not limited to, cytokines, antigens or auto-antibodies)of a proliferative cellular response, the production of solublemediators (including but not limited to cytokines, oxygen radicals,enzymes, prostanoids, or vasoactive amines), or cell surface expressionof new or increased numbers of mediators (including, but not limited to,major histocompatability antigens or cell adhesion molecules) ininflammatory cells (including but not limited to monocytes, macrophages,T lymphocytes, B Lymphocytes, granulocytes, polymorphonuclearleukocytes, mast cells, basophils, eosinophils, dendritic cells, andendothelial cells). It will be appreciated by persons skilled in the artthat the activation of one or a combination of these phenotypes in thesecells can contribute to the initiation, perpetuation, or exacerbation ofan inflammatory condition.

Methods, compounds and compositions of the invention are useful intreating such diseases as arthritic diseases (such as rheumatoidarthritis), osteoarthritis, gouty arthritis, spondylitis,thyroid-associated opthalmopathy, Behcet disease, sepsis, septic shock,endotoxic shock, gram negative sepsis, gram positive sepsis, toxic shocksyndrome, asthma, chronic bronchitis, allergic rhinitis, allergicconjunctivitis, vernal conjunctivitis, eosinophilic granuloma, adult(acute) respiratory distress syndrome (ARDS), chronic pulmonaryinflammatory disease (such as chronic obstructive pulmonary disease),silicosis, pulmonary sarcoidosis, reperfusion injury of the myocardium,brain or extremities, brain or spinal cord injury due to minor trauma,fibrosis including cystic fibrosis, keloid formation, scar tissueformation, atherosclerosis, autoimmune diseases, such as systemic lupuserythematosus (SLE) and transplant rejection disorders (e.g., graft vs.host (GvH) reaction and allograft rejection), chronicglomerulonephritis, inflammatory bowel diseases, such as Crohn's diseaseand ulcerative colitis, proliferative lymphocytic diseases, such asleukemias (e.g. chronic lymphocytic leukemia; CLL) (see Munoz et al., J.Exp. Med. 172:95-103 (1990); Mentz et al., Blood 88:2172-2182 (1996)),and inflammatory dermatoses, such as atopic dermatitis, psoriasis, orurticaria.

C. Thrombosis-Related Conditions

It is also contemplated that the compounds, compositions and methods ofthe present invention are used in the treatment of a variety ofdisorders in which there is a need to prevent or treat thrombosis andsubsequent decrease or loss of blood flow. The examples of thromboticdisorders include but not limited to atherosclerosis, myocardialinfarction, stroke, and kidney ischemia, and thrombosis in any part ofthe mammalian body. The composition of the present invention will alsobe used in the prevention and treatment of microangiopathy in whichformation of microthrombi or von Willebrand factor (VWF) binding toplatelets causes excessive consumption of platelets and/or VWF leadingto subsequent bleeding diathesis. Examples of latter disorders includebut not limited to thrombotic thrombocytopenic purpura, type II andplatelet type von Willebrand disease (VWD). The compounds or combinationtherapeutic methods of the present invention inhibit VWF-dependentplatelet adhesion and aggregation. The compounds, compositions andmethods are also useful in prolonging bleed time in a mammal and assuch, are useful as anti-thrombotic agents both in therapeutic andprophylactic methods. As such, these compounds, compositions and methodsare useful as anticoagulant agents and/or anti-platelet agents. Further,the present invention provides compounds, compositions and methods forthe treatment of thrombosis and other disorders of the cardiovascularcirculatory system that require and increase in the flow or reducingblockage of the vessels.

Compounds, compositions and methods are also useful for the treatment ofany disorder that is presently treated using anticoagulant therapy. Suchdisorders include pulmonary embolism, unstable angina, myocardialinfarction, deep vein thrombosis, atrial fibrillation with embolization,acute and chronic coagulopathies (disseminated intravascularcoagulation), for prevention of clotting in arterial and cardiacsurgery, for prophylaxis and treatment of peripheral arterial embolism.The compounds, compositions and methods are also used to treatthrombotic thrombocytopic purpura, other types of microangiopathy thatare mediated by spontaneous interaction between VWF and platelets,platelet type or type IIb von Willebrand diseases in which there is anincreased binding of VWF to platelets (either caused by a defect in GPIbor in VWF). The compounds, compositions and methods described herein areuseful as anti-platelet agents in blood transfusions, extracorporealcirculation, dialysis procedures as well as blood sampling forlaboratory procedures. The compounds, compositions and methods are alsoused to maintain the patency of an indwelling venipucture device that isbeing used for intermittent injection or infusion therapy or bloodsampling. The compounds, compositions and methods are particularlyuseful in surgical procedures to prevent the formation of blood clots.Such indications are particularly desirable for patients undergoingabdominal surgery to reduce the risk of thromboemolic complications,patients undergoing knee or hip replacement therapy during and followingthe replacement procedure, as well as a general prophylactic to preventclot formation at a later stage. The compounds, compositions and methodsare further useful in the treatment of subjects that are under risk ofthromboembolic complications due to severely restricted mobility e.g.,during acute illness. Any such disorders may be readily treated by thecompositions described herein. The therapeutic methods include bothmedical therapeutic and/or prophylactic administration, as appropriate.

As used herein, the term “inhibits platelet aggregation” includes itsgenerally accepted meaning which includes prohibiting, slowing, orreducing the severity or degree of platelet aggregation. Such aninhibition may be measured as a function of time taken for a givensample to coagulate. In other embodiments, animal models of thrombosis.Methods of determining the efficacy of the agents include coagulationtesting, monitoring the time of bleeding, determining hemoglobin levelsof an animal and the like.

VI. Combination Therapy

The invention further provides combination therapy, wherein thecompounds and/or compositions of the invention are administered with oneor more additional agent(s) In general, the therapeutic methods,compositions and compounds may also be employed in combination withother therapeutics in the treatment of various disease states, with theadditional agents being administered concurrently or sequentially with acomposition of the invention.

A. Cytokines

Exemplary cytokines or hematopoietic factors for such co-administrationinclude IL-1 alpha, IL-1 beta, IL-2, IL-3, IL-4, IL-5, IL-6, IL-11,colony stimulating factor-1 (CSF-1), M-CSF, SCF, GM-CSF, granulocytecolony stimulating factor (G-CSF), EPO, interferon-alpha (IFN-alpha),consensus interferon, IFN-beta, IFN-gamma, IFN-omega, IL-7, IL-8, IL-9,IL-10, IL-12, IL-13, IL-14, IL-15, IL-16, IL-17, IL-18, IL-19, IL-20,IL-21, IL-22, IL-23, IL-24, IL-31, IL-32 alpha, IL-33, thrombopoietin(TPO), angiopoietins, for example Ang-1, Ang-2, Ang-4, Ang-Y, the humanangiopoietin-like polypeptides ANGPTL1 through 7, vitronectin, vascularendothelial growth factor (VEGF), angiogenin, activin A, activin B,activin C, bone morphogenic protein-1, bone morphogenic protein-2, bonemorphogenic protein-3, bone morphogenic protein-4, bone morphogenicprotein-5, bone morphogenic protein-6, bone morphogenic protein-7, bonemorphogenic protein-S, bone morphogenic protein-9, bone morphogenicprotein-10, bone morphogenic protein-11, bone morphogenic protein-12,bone morphogenic protein-13, bone morphogenic protein-14, bonemorphogenic protein-15, bone morphogenic protein receptor IA, bonemorphogenic protein receptor IB, bone morphogenic protein receptor II,brain derived neurotrophic factor, cardiotrophin-1, ciliary neutrophicfactor, ciliary neutrophic factor receptor, cripto, cryptic,cytokine-induced neutrophil chemotactic factor 1, cytokine-inducedneutrophil, chemotactic factor 2a, cytokine-induced neutrophilchemotactic factor 2β, β endothelial cell growth factor, endothelin 1,epidermal growth factor, epigen, epiregulin, epithelial-derivedneutrophil attractant, fibroblast growth factor 4, fibroblast growthfactor 5, fibroblast growth factor 6, fibroblast growth factor 7,fibroblast growth factor 8, fibroblast growth factor 8b, fibroblastgrowth factor 8c, fibroblast growth factor 9, fibroblast growth factor10, fibroblast growth factor 11, fibroblast growth factor 12, fibroblastgrowth factor 13, fibroblast growth factor 16, fibroblast growth factor17, fibroblast growth factor 19, fibroblast growth factor 20, fibroblastgrowth factor 21, fibroblast growth factor acidic, fibroblast growthfactor basic, glial cell line-derived neutrophic factor receptor α1,glial cell line-derived neutrophic factor receptor α2, growth relatedprotein, growth related protein α, growth related protein β, growthrelated protein γ, heparin binding epidermal growth factor, hepatocytegrowth factor, hepatocyte growth factor receptor, hepatoma-derivedgrowth factor, insulin-like growth factor I, insulin-like growth factorreceptor, insulin-like growth factor II, insulin-like growth factorbinding protein, keratinocyte growth factor, leukemia inhibitory factor,leukemia inhibitory factor receptor α, nerve growth factor nerve growthfactor receptor, neuropoietin, neurotrophin-3, neurotrophin-4,oncostatin M (OSM), placenta growth factor, placenta growth factor 2,platelet-derived endothelial cell growth factor, platelet derived growthfactor, platelet derived growth factor A chain, platelet derived growthfactor AA, platelet derived growth factor AB, platelet derived growthfactor B chain, platelet derived growth factor BB, platelet derivedgrowth factor receptor α, platelet derived growth factor receptor β,pre-B cell growth stimulating factor, stem cell factor (SCF), stem cellfactor receptor, TNF, including TNF0, TNF1, TNF2, transforming growthfactor α, transforming growth factor β, transforming growth factor β1,transforming growth factor β1.2, transforming growth factor β2,transforming growth factor β3, transforming growth factor β5, latenttransforming growth factor β1, transforming growth factor β bindingprotein I, transforming growth factor β binding protein II, transforminggrowth factor β3 binding protein III, thymic stromal lymphopoietin(TSLP), tumor necrosis factor receptor type I, tumor necrosis factorreceptor type II, urokinase-type plasminogen activator receptor,vascular endothelial growth factor, and chimeric proteins andbiologically or immunologically active fragments thereof.

B. Atherosclerosis Drugs

Additional active agents may act in complementary or synergistic wayswith the modified LCAT protein when used to treat, and preventatherosclerosis or manage cholesterol, or related disorders such ascardiovascular disease.

In one aspect, compounds of the invention can be used with statins.Statins are drugs that competitively inhibit 3-hydroxy-3-methylglutarylcoenzyme A reductase “HMG-CoA reductase,” which is the enzyme thatcatalyzes an early, rate-limiting step in cholesterol biosynthesis.Hebert et al., JAMA 1997, 278: 313-21. This combination, in addition toraising HDL levels and lowering LDL levels may also lowers triglycerideand reduce inflammation. It is believed that the combination can haveadditional therapeutic effects, for example, the combination may lowerblood pressure; protect against heart disease, for example, by reducingsmooth muscle proliferation, reduce heart attacks, reduce plateletaggregation, and to reduce strokes as well as peripheral arterialdisease (clogging of the arteries to the legs).

Examples of statins of the invention include, but are not limited to,mevastatin, pitavastatin, rosuvastatin, pentostatin (Nipent®), nystatin,lovastatin (Mevacor®), simvastatin (Zocor®), pravastatin (Pravachol®),fluvastatin (Lescol®), atorvastatin (Lipitor®), cerivastatin (Baycol®),or combinations thereof. Statins suitable for use in the compositionsand methods of the invention are also disclosed in U.S. Pat. Nos.4,681,893; 5,273,995; 5,356,896; 5,354,772; 5,686,104; 5,969,156; and6,126,971. As some statins may exist in an inactive form, such as alactone (e.g., simvastatin), the invention encompasses using the activeform (e.g., b-hydroxy acid form) of them. See Physicians Desk Reference,54.sup.th Ed. (2000) pp. 1917-1920.

Fibrates or fibric acid derivatives are regarded as broad-spectrumlipid-modulating agents in that although their main action is todecrease serum triglycerides they also tend to reduce LDL-cholesteroland to raise HDL-cholesterol. It is believed that the combined use ofcompounds of the invention and a fibrate may reduce the risk of coronaryheart disease events in those with low HDL-cholesterol or with raisedtriglycerides by speeding up the chemical breakdown (i.e., catabolism)of triglyceride-rich lipoproteins that circulate in the body.

Fibrates include, but are not limited to, bezafibrate, ciprofibrate,fenofibrate, gemfibrozil, clofibrate, or combinations thereof. Fibratessuitable for inclusion in the compositions or administration in themethods of the invention are disclosed in U.S. Pat. Nos. 4,895,762;6,074,670; and 6,277,405.

Biguanides for use in the compositions and methods of the inventioninclude, but are not limited to, metformin, phenformin, buformin, orcombinations thereof. Biguanides suitable for use in the compositions ormethods of the invention are also disclosed in U.S. Pat. No. 6,303,146.The combined use of compounds of the invention and a bigaunide mayimprove glycemic control by enhancing insulin sensitivity in the liverand in muscle. The combination may reduce or avoid cardiovascular riskfactors such as dyslipidemia, elevated plasminogen activator inhibitor 1levels, other fibrinolytic abnormalities, hyperinsulinemia, insulinresistance, and is an effective and safe therapeutic agent for thetreatment of type 2 diabetes.

In another aspect, compounds of the invention may be used in combinationwith glitazones, which may increase glucose uptake in muscle and reducedendogenous glucose production. Glitazones include5-((4-(2-(methyl-2-pyridinylamino)ethoxy)-phenyl)methyl)-2,4-thiazolidinedione, troglitazone,pioglitazone, ciglitazone, WAY-120,744, englitazone, AD 5075,darglitazone, rosiglitazone, combinations thereof, or a pharmaceuticallyacceptable salt, solvate, clathrate, polymorph, prodrug, orpharmacologically active metabolite thereof. Glitazones suitable for usein the compositions or methods of the invention are disclosed in U.S.Pat. Nos. 4,687,777; 5,002,953; 5,741,803; 5,965,584; 6,150,383;6,150,384; 6,166,042; 6,166,043; 6,172,090; 6,211,205; 6,271,243;6,288,095; 6,303,640; and 6,329,404.

Compositions comprising modified LCAT proteins of the invention and asulfonylurea or a derivative thereof may increase insulin release fromthe pancreas and may further insulin levels by reducing hepaticclearance of the hormone. Sulfonylurea-based drugs for use thecompositions and methods of the invention include, but are not limitedto, glisoxepid, glyburide, acetohexamide, chlorpropamide, glibomuride,tolbutamide, tolazamide, glipizide, gliclazide, gliquidone, glyhexamide,phenbutamide, tolcyclamide, combinations thereof, or a pharmaceuticallyacceptable salt, solvate, or clathrate.

Combination compositions may also include agents that inhibit CETP. Suchagents are, for example, Torcetrapib, andS-(2-[([1-(2-ethylbutyl)cyclohexyl]carbonyl)amino]phenyl)-2-methylpropanethioate.

Additional active agents also include cardiovascular drugs.Cardiovascular drugs for use in combination with the compounds of theinvention to prevent or treat cardiovascular diseases include peripheralantiadrenergic drugs, centrally acting antihypertensive drugs (e.g.,methyldopa, methyldopa HCl), antihypertensive direct vasodilators (e.g.,diazoxide, hydralazine HCl), drugs affecting renin-angiotensin system,peripheral vasodilators, phentolamine, antianginal drugs, cardiacglycosides, inodilators (e.g., aminone, milrinone, enoximone,fenoximone, imazodan, sulmazole), antidysrhythmic drugs, calcium entryblockers, ranitine, bosentan, and rezulin.

Depending on the disorder for which treatment is sought, compounds andcompositions of the invention are used in combination therapy with othertherapeutics that achieve a specific biological effect.

1. Cholesterol Lowering Drugs

Various medications can lower blood cholesterol levels. They may beprescribed individually or in combination with other drugs. Some of thecommon types of cholesterol-lowering drugs include statins, resins andnicotinic acid (niacin), gemfibrozil and clofibrate. Thus, combinationtherapy is contemplated utilizing, for example, clofibrate (Atromid-S,which raises the HDL cholesterol levels and lowers triglyceride levels),gemfibrozil (Lopid, which raises HDL cholesterol levels), nicotinic acid(which works in the liver by affecting the production of blood fats andis used to lower triglycerides and LDL cholesterol, and raise HDL(“good”) cholesterol), resins (which are also called bile acid-bindingdrugs and work in the intestines by promoting increased disposal ofcholesterol), including cholestyramine (Questran, Prevalite,Lo-Cholest), colestipol (Colestid) and colesevelam (WelChol), andstatins including atorvastatin (Lipitor), fluvastatin (Lescol),lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin calcium(Crestor), and simvastatin (Zocor).

The drugs of first choice for elevated LDL cholesterol are the HMG CoAreductase inhibitors, e.g., atorvastatin, fluvastatin, lovastatin,pravastatin, rosuvastatin and simvastatin. Statin drugs are effectivefor lowering LDL cholesterol levels, have few immediate short-term sideeffects, are easy to administer, have high patient acceptance and havefew drug-drug interactions.

Another class of drugs for lowering LDL is the bile acidsequestrants—colesevelam, cholestyramine and colestipol—and nicotinicacid (niacin), which have been shown to reduce the risk for coronaryheart disease in controlled clinical trials. Both classes of drugsappear to be free of serious side effects. But both can have troublesomeside effects and require considerable patient education to achieveadherence. Nicotinic acid can be used by patients with triglyceridelevels that exceed 250 mg/dL because bile acid sequestrants tend toraise triglyceride levels.

2. ACE Inhibitors

Angiotensin II causes blood vessels to contract and thereby narrows theblood vessels. The narrowing of the vessels increases the pressurewithin the vessels and can cause high blood pressure (hypertension).Angiotensin II is formed from angiotensin I in the blood by the enzyme,angiotensin converting enzyme (ACE). ACE inhibitors decrease theproduction of angiotensin II. As a result, the blood vessels enlarge ordilate, and the blood pressure is reduced. ACE inhibitors that availablein the United States include captopril (Capoten), benazepril (Lotensin),enalapril (Vasotec), lisinopril (Prinivil, Zestril) fosinopril(Monopril), ramipril (Altace), perindopril (Aceon), quinapril(Accupril), moexipril (Univasc), and trandolapril (Mavik).

C. Anti-Inflammatory Drugs

In prevention and treatment of inflammation, combination therapy iscontemplated with, for example, acetylsalicylic acid (Aspirin, Ecotrin),choline magnesium salicylate (Trilisate), diclofenac (Voltaren,Cataflam, Voltaren-XR), diflunisal (Dolobid), etodolac (Lodine),fenoprofen (Nalfon), flurbiprofen (Ansaid), ibuprofen (Advil, Motrin,Medipren, Nuprin), indomethacin (Indocin, Indocin-SR), ketoprofen(Orudis, Oruvail), meclofenamate (Meclomen), nabumetone (Relafen),naproxen (Naprosyn, Naprelan, Anaprox, Aleve), oxaprozin (Daypro),phenylbutazone (Butazolidine), piroxicam (Feldene), salsalate (Disalcid,Salflex), tolmetin (Tolectin), valdecoxib (Bextra), and COX-2 selectivenon-steroidal anti-inflammatory drugs (NSAIDs) including Bextra,Celebrex, Naproxen, and Vioxx. Prescription-only NSAIDs includeibuprofen (Brufen), aceclofenac (Preservex), acemetacin (Emflex),azapropazone (Rheumox), celecoxib (Celebrex), dexketoprofen (Keral),diclofenac (Voltarol, Diclomax, Arthrotec), diflusinal (Dolobid),etodolac (Lodine), fenbufen (Lederfen), fenoprofen (Fenopron),flurbiprofen (Froben), indometacin, ketoprofen (Orudis, Oruvail),mefenamic acid, meloxicam (Mobic), nabumetone (Relifex), naproxen(Naprosyn, Synflex), phenylbutazone (Butacote), piroxicam (Feldene),sulindac (Clinoril), tenoxicam (Mobiflex) and tiaprofenic acid (Surgam),

D. Anti-Thrombosis Drugs

In methods for prevention and treatment of thrombosis-relatedconditions, combination therapy is contemplated with anti-thrombosisdrugs such as anticoagulant drugs, which inhibit the ability of blood toclot, or coagulate and include dalteparin (Fragmin), danaparoid(Orgaran), enoxaparin (Lovenox), heparin (various), tinzaparin(Innohep), warfarin (Coumadin), and lepirudin (Refludan), andantiplatelet drugs such as aspirin, ticlopidine (Ticlid), clopidogrel(Plavix), tirofiban (Aggrastat) and eptifibatide (Integrilin). Stillother methods include the use of bivalirudin (selective and reversiblethrombin inhibitor), argatroban (reversible inhibitor of thrombin), andlow molecular weight heparins (LMWHs), including enoxaparin (Lovenox),dalteparin (Fragmin), ardeparin (Normiflo) fondaparinux and idraparinux.Still other anti-thrombosis drugs contemplated for use in methods of theinvention include fragmin (dalteparin sodium injection) lovenox(enoxaparin sodium), Normiflo (ardeparin sodium), Orgaran (danaparoidsodium), indirect (Antithrombin-Dependent) FXa inhibitors such asfondaparinux (Arixtra®) and idraparinux, direct(Antithrombin-Independent) FXa inhibitors such as BAY 59-7939 [Bayer],DPC-423 [Bristol-Myers Squibb], DX-9065a [Daiichi], LY517717, razaxaban(DPC906), lepirudin (Refludan®), desirudin (Revasc®), bivalirudin(Hirulog®, Angiomax®), argatroban (Novastan®), melagatran, andximelagatran (Exanta®).

It should be understood that the disorder that may be treated by thecompositions of the present invention are limited only by the fact thatthe disorder needs a therapeutic intervention which inhibits plateletaggregation. The doses of the agent may be modified for each individualsubject. For particular guidance on the routes of administration, anduses those of skill in the art are referred to the Physician's DeskReference for generalized descriptions of formulations, routes ofadministration and patient monitoring used for agents such as Aggrastat™(see e.g., entry at pages 1933-1937, PDR, 57th Edn., 2003), Aggrenox™(see e.g., entry at pages 1023-1026, PDR, 57th Edn., 2003), Agrylin™(see e.g., entry at pages 3142-3143, PDR, 57th Edn., 2003), Flolan™ (seee.g., entry at pages 1516-1521, PDR, 57th Edn., 2003), Integrilin™ (seee.g., entry at pages 2138-2142, PDR, 57th Edn., 2003), Presantine™ (seee.g., entry at pages 1052-2053, PDR, 57th Edn., 2003), Plavix™ (seee.g., entry at pages 1098-1101, PDR, 57th Edn., 2003), Pletal™ (seee.g., entry at pages 2780-2782, PDR, 57th Edn., 2003), REoPro™ (seee.g., entry at pages 1866-1870, PDR, 57th Edn., 2003), Coumdin™ (seee.g., entry at pages 1074-1079, PDR, 57th Edn., 2003), Fragmin™ (seee.g., entry at pages 2750-2754, PDR, 57th Edn., 2003), Hep-Lock™ (seee.g., entry at pages 1284-1288, PDR, 57th Edn., 2003), Lovenox™ (seee.g., entry at pages 739-744, PDR, 57th Edn., 2003), Miradon™ (see e.g.,entry at pages 3051-3052, PDR, 57th Edn., 2003). These entries in thePDR are provided to show the level of skill in the art relating toformulating and using compositions as anticoagulants and anti-plateletagents.

E. Anti-Diabetic Drug.

Combination therapy using anti-diabetic drugs that lower blood glucoselevels is also contemplated. Except for insulin, exenatide, andpramlintide, antidiabetics are administered orally and are thus alsocalled oral hypoglycemic agents or oral antihyperglycemic agents.Antidiabetic drugs divided into six groups: insulin, sulfonylureas,alpha-glucosidase inhibitors, biguanides, meglitinides, andthiazolidinediones.

Insulin (Humulin, Novolin) controls blood glucose levels. Forms includeisophane insulin suspension, insulin zinc suspension, and otherformulations that extend the duration of insulin action. Use of inhaledforms of insulin are also contemplated.

Sulfonylureas increase insulin release from the beta cells of thepancreas, and include chlorpropamide [Diabinese], tolazamide [Tolinase],glipizide [Glucotrol], glimepiride (Amaryl), tolbutamide (Orinase),acetohexamide (Dymelor), glyburide (Diabeta, Micronase, Glynase), andgliclazide (Diamicron).

Alpha-glucosidase inhibitors inhibit the conversion of disaccharides andcomplex carbohydrates to glucose, and are used in combination therapywith sulfonylureas or other hypoglycemic agents. This type ofanti-diabetic agent includes acarbose [Precose] and miglitol [Glyset].

The biguanide class of compounds mentioned above decreases hepaticglucose production, decreases intestinal absorption of glucose andincreases peripheral glucose uptake and use.

The meglitinide class of compounds stimulates insulin production and maybe used in combination with metformin. This class includes repaglinide(Prandin) and nateglitinide (Starlix).

Thiazolidinedione agent reduce glucose production in the liver andincrease insulin-dependent glucose uptake in muscle cells. These agentsmay be used in combination with metformin or a sulfonylurea, and includerosiglitazone (Avandia) and pioglitazone (Actos).

Combination therapy with anti-diabetic peptide analogs is alsocontemplated. Such analogs include incretins which are insulinsecretagogues, including glucagon-like peptide-1 (GLP-1) and gastricinhibitory peptide (also known as glucose-dependent insulinotropicpeptide or GIP). Both GLP-1 and GIP are inactivated by the dipeptidylpeptidase-4 (DPP-4). Other peptides include Exenatide (also Exendin-4,sold as Byetta) which is a GLP agonist. and is more resistant todegradation by DPP-4; dipeptidyl peptidase-4 (DPP-4) inhibitors whichmaintain blood concentration of GLP-1 by inhibiting its degradation bydipeptidyl peptidase-4 (DPP-4), this class of peptides includingvildagliptin and sitagliptin, and amylin agonist analogues which slowgastric emptying and suppress glucagons, this type including pramlintide

It is understood that the application of the teachings of the presentinvention to a specific problem or situation will be within thecapabilities of one having ordinary skill in the art in light of theteachings contained herein. Examples of the products of the presentinvention and representative processes for their isolation, use, andmanufacture appear below.

Example 1 Preparation of Modified LCAT Protein

A polynucleotide encoding wild type human LCAT protein (SEQ ID NO: 1)was cloned from human liver cDNA library. DNA encoding the wild typehuman LCAT protein was mutagenized using Quickchange site-directedmutagenesis kit (Stratagene) well known and routinely utilized in theart.

Briefly, primer pairs containing the designed mutations wereincorporated into the newly synthesized DNA molecules. The newlysynthesized LCAT coding sequence was tagged with a polynucleotideencoding human Fc fragment at the C-terminus of the encoded protein. Theparental template was digested with Dpn I endonuclease. The nickedvector DNA containing the desired mutants was transformed into XL1-BlueE. coli. Plasmids encoding mutant LCAT were recovered from thetransformed E. coli. The presence of the mutations in the plasmids wasconfirmed by DNA sequencing analysis and the mutant LCAT-Fc constructswere transfected into CHO cells for protein expression using DHFR-basedvector set and chemically-defined media. Recombinant human LCAT-Fc(rhLCAT-Fc) fusion mutant proteins (i.e., modified LCAT proteins) wereisolated from culture media of transfected CHO cells. Productions (i.e.,fermentations) have involved growth of transfected CHO cells in eithershaker flasks or bioreactor vessels with rhLCAT-Fc secreted to themedium.

Purification of Fc-fused modified human LCAT proteins was performed asfollows. Cultures were typically harvested after 4-6 days of proteinproduction and crude supernatant was isolated from cells viacentrifugation or hollow fiber filtration for shaker flask andbioreactor productions, respectively. The crude mixture was then eitherloaded directly or concentrated 10×-20× and buffer-exchanged into 20 mMsodium phosphate, pH 7.2, 300 mM NaCl, 0.05% azide and loaded ontomAbSelect Sure resin (GE Biosciences). The resin was then washed withthe same high salt phosphate buffer 5-10 times and the bound protein waseluted with 300 mM citrate, pH 3.4. Eluted fractions were neutralizedwith 1 M Tris buffer, pH 8.0. In order to enrich the Protein A affinitypurified material to greater than 90% full-length protein,high-resolution Hydrophobic Interaction Chromatography (HIC)chromatography was utilized. A pH-neutralized pool was loaded directlyonto a pre-packed Biosuite Phenyl HIC column (Waters) resulting in thebulk of the clipped species flowing through, and the bulk of thefull-length protein adhering to the column. Modified LCAT-Fc proteinswere eluted via a linear gradient to 100% Milli-Q H₂O. Fractions wereanalyzed for percentage of the full-length LCAT via N-terminal sequence(NTS) and were pooled accordingly. An HIC pool was then concentrated andfurther purified via preparative size-exclusion chromatography (SEC)with PBS, pH 7.2, 10% glycerol, 50 μM EDTA as the mobile phase. Thenon-aggregated SEC product was concentrated to 5 mg/mL if necessary,aliquoted and flash frozen.

Example 2 Screens for Modified LCAT Proteins

LCAT Enzyme Activity

Activity of the modified LCAT proteins was determined by measuring thechange of the rate of conversion of ³H-labeled cholesterol (FC) tocholesteryl ester (CE). In the plasma LCAT activity assay (CER), humanplasma samples were equilibrated with a trace amount of radiolabeledcholesterol at 4° C. and the rate of cholesterol esterification wasmeasured by thin layer chromatography (TLC) analysis after incubation at37° C. (Dobiasova and Frohlich, Physiol Res. 1996; 45, 65-73).

For measuring compound activity using apoAI-liposome assay format,modified LCAT protein was expressed in CHO cells and enzyme secretedfrom the stably transfected cells was harvested in the serum-freeculture medium. The activity of the modified LCAT enzyme in the culturemedia was determined using apoAI-liposome substrates prepared by thestandard cholate-dialysis procedure (Chen et al. (1982) J. Lipid Res.23: 680-691). The initial mixture contained egg phosphatidylcholine (PC)(Sigma), /³H-unesterfied cholesterol/human apoAI (molar ratio of250:12.5:0.8). After dialysis the proteoliposomes were incorporated withthe modified LCAT protein. LCAT activity was determined by measuring theconversion of radiolabeled cholesterol to cholesteryl ester andexpressed in nmol CE/mL per hour. The activity of the modified LCATenzyme in the purified form was measured using the same assay, exceptthat recombinant LCAT protein was purified either with standard ProteinA-affinity colume that specifically recognized the Fc fusion fragment ofthe recombinant protein, or with affinity resin that specificallyrecognize the His tag of the recombinant protein. LCAT activity ofpurified samples was expressed in nmol CE/μg/hour.

Activity ranges of the exemplary modified LCAT proteins are summarizedin Table 3.

TABLE 3 LCAT Activity Position Modified LCAT protein (nmol/h/μg) Wildtype Wild type sequence + Addition of Q before first amino ++ acidAddition of P between amino acids 1 ++ and 2 Using mouse Kappa chainsignal ++ peptide Using human IgG1 signal peptide ++ N-terminal humanIgG1 Fc-fusion − Addition of FWLLNV at N-terminal ++ Addition ofFWLLNVLFPP at N- ++ terminal Addition of FWLLNVLFPP at C- +++ terminalF1 F1A ++ F1G ++ F1I ++ F1L ++ F1M ++ F1P ++ F1V ++ F1C ++ F1W +++ F1Y++ F1T ++ F1S +++ F1Q ++ F1N ++ F1H ++ F1D ++ L3 L3I ++ L3F ++ L3C ++L3W ++ L3Y ++ L4A ++ L4 L4I ++ L4M ++ L4F ++ L4V ++ L4W ++ L4Y ++ L4T ++L4Q ++ L4R ++ N5A ++ N5 N5M ++ N5M ++ N5H ++ N5K ++ N5D ++ N5E ++ V6 L7M++ L7F ++ L7E ++ C31A ++ C31I +++ L7 C31M ++ C31F +++ C31V ++ C31C ++C31W ++ C31Y +++ C31T ++ C31R ++ C31H ++ N384C ++ C31 N384Q ++ E416C ++F1A-C31Y ++ L4F-C31Y +++ N4E-C31Y ++ N5Q-C31Y ++ N5D-C31Y +++ N5A-C31Y+++ T246N V28A-C31I ++ N384 V28I-C31I ++ W2-C31 V28C-C31I ++ N5-C31V28T-C31I ++ L4-C31 V28R-C31I ++ N5-C31 P29GC31-I ++ P29F-C31I ++P29T-C31I ++ V28-C31 G30A-C31I ++ G30I-IC31 ++ C21I-L32A ++ IC31-IL32 ++C31I-L32M ++ C31I-L32F +++ C31I-L32C ++ C31I-L32W ++ C31I-L32Y ++C31I-L32T ++ C31I-L32S ++ C31I-L32N ++ C31I-L32H +++ P29-C31 C31I-L32E++ C31I-G33I ++ C31I-G33M ++ C31I-G33F ++ C31I-G33S ++ C31I-G33H ++C31I-N34A ++ G30-C31 G30A-C31I ++ G30I-IC31 ++ C31-L32 C21I-L32A ++IC31-IL32 ++ C31I-L32M ++ C31I-L32F +++ C31I-L32C ++ C31I-L32W ++C31I-L32Y ++ C31I-L32T ++ C31I-L32S ++ C31I-L32N ++ C31I-L32H +++C31I-L32E ++ C31-G33 C31I-G33I ++ C31I-G33M ++ C31I-G33F ++ C31I-G33S ++C31I-G33H ++ C31-N34 C31I-N34A ++ C31I-N34C ++ C31I-N34S ++ C31I-N34R+++ As used herein, “+” is the activity of the wild type protein; “++” -LCAT enzymatic activity is in the range from −20% to +50% of wild typeprotein activity; “+++” - LCAT activity is at least 50% higher than thatof the wild type protein as measured in the same experimental setting.“−” indicates that activity is below detectable level.

Modified LCAT proteins with enzymatic activity of at least 20% higherthan that of the wild type LCAT protein were purified on a larger scalefor determining the N-terminal sequences of the modified LCAT protein.Modified LCAT proteins maintaining intact N-terminal sequence withoutany clipping, were subjected to further evaluation of stability and invivo efficacy.

In Vivo Efficacy and Stability of the Modified LCAT Protein Entities

Modified LCAT protein molecules were evaluated in animal modelsincluding mice, hamsters and rabbits. The readouts for in vivoevaluation included efficacy of increasing plasma HDL-Cholesterol(HDL-C) levels and stability (PK). Animals of choice were treated withsingle dosing or multiple dosing of modified LCAT protein and during theperiod of time up to 255 hours, plasma samples were isolated fromanimals and measurements were conducted.

HDL-C was determined enzymatically using Polyethylene Glycol(PGE)—modified enzyme and dextran sulfate, as described in the manual ofHDL-C plus 3^(rd) generation kit, cobas, (Cat. No. 04713311 190), andusing automated analyzer Roche/Hitachi 904/911/912/MODULAR analyzers CAN435.

PK was measured as follows. Briefly, the assay used fordetermining-recombinant LCAT-Fc protein concentrations was a sandwichELISA method developed at Amgen. Mouse anti-LCAT clone 9B14A12 wasdiluted in phosphate buffered saline (PBS), then coated onto the wellsof a 96-well microtiter plate (Maxisorp, Nunc) and incubated overnightat 5°±3° C. The plate was washed 3 times with 1× KPL Wash Buffer. Ablocking buffer comprised of 10% non-fat dried milk (NFDM) in PBS+0.05%Tween-20 (PBST) was dispensed into the wells. After a minimum ofone-hour ambient room temperature (ART) incubation without agitation,the blocking buffer was removed from the wells. Next, the LCAT-Fc assaystandards, NSB, and quality control samples (QCs), which were preparedin 100% New Zealand white rabbit serum and pretreated at a dilutionfactor of 50 in PBST+10% NFDM, were added to the plate along with rabbitserum specimens that were also pretreated in PBST+10% NFDM. Following aone-hour ART incubation with agitation, the plate was washed six timeswith 1×KPL Wash Buffer, then a horseradish peroxidase-labeled goatanti-rabbit Fc with minimal cross-reactivity to human serum protein(Jackson; #111-035-046) was diluted at a dilution factor of 25,000 in10% NFDM containing 2% pooled rabbit serum and added to the wells fordetection of LCAT-Fc. After a one-hour ART incubation with agitation,the plate was washed and developed using TMB substrate solution (1:1tetramethylbenzidine and peroxide, Kirkegaard & Perry Laboratories). Theresulting colorimetric reaction was quenched with 1+9 phosphoric acid(VWR; #VW3346-1) after a ten-minute ART incubation and optical densities(ODs) were determined at a wavelength of 450-650 nm. The conversion ofOD values into concentrations for the QCs and unknown specimens wasachieved through Watson software mediated comparison to a concurrentlyanalyzed standard curve, which was regressed according to afour-parameter logistic model with a weighting factor of 1.

Results showed that tested modified LCAT protein had improved stabilitycompared to wild type LCAT protein and that HDL was robustly increasedin a dose dependent manner. Modified LCAT protein molecules showingefficacy in raising plasma HDL-C levels and acceptable in vivo stabilitywere further analyzed in preclinical atherosclerosis models.

Atherosclerosis Animal Models

This study involved the use of wild type New Zealand White (NZW)rabbits. Animals were treated with atherogenic (high-cholesterol) dietfor 4 months to induce atherosclerosis, followed with the treatmentusing modified LCAT for atherosclerosis regression. Animals were dividedinto 4 groups for treatments: a) vehicle; b) low rLCAT dose and c) highrLCAT dose; and d) no treatment but terminating the animals for basalline of plaque lesion, respectively. The treatment duration was set for8-16 weeks depending on if adverse effects occur along the course. Atthe end of the treatment atherosclerotic lesions were evaluated. Theprocedure for assessing atherosclerotic plaque was as following.

Briefly, animals were anesthetized using pentobarbital and then salineperfusion was conducted, followed by fixation with paraformaldehyde.Aorta was isolated by removing all attached organs and fat tissues andsplit from distal to proximal. Aorta was then pinned on wax plates andstained using Sudan IV. Light microscope photograph was used to quantifyplaque lesion area and stain was analyzed using Image-Pro software.

Example 3 Recombinant LCAT Protein with Double Mutations

In view of the activity measurements observed above with various LCATmutations, a number of double mutants comprising a C31Y substitution andan additional substitution, as shown below, were prepared and assessedfor activity by the ability to convert of radiolabeled cholesterol (FC)into cholesteryl ester (CE), as described before.

Results are shown below in Table 4 with the double mutants compared towild-type protein and the single mutant C31Y LCAT protein. As used inTable 4, “−” indicates enzyme activity was below the detection level;“+” is shown as the wild-type LCAT protein activity; “++” indicatesenzyme activity was in the range of −20% to +50% of wild-type proteinactivity; “+++” indicates activity in the range of +100% to +500% ofwild-type protein activity; and “++++” indicates enzyme activity greaterthan +500% of wild-type LCAT activity.

TABLE 4 LCAT Protein LCAT activity (nmol/h/μg) Wild-type + C31Y +++C31Y, F1S +++ C31Y, F1W ++++ C31Y, L4M ++ C31Y, L4K + C31Y, N34S +++C31Y, L32F +++ C31Y, L32H +++ C31Y, L7N −

Example 4 In Vivo Comparison Between Wild-Type and Modified LCATProteins

In order to individually assess in vivo activity of a modified LCATprotein compared to wild-type LCAT individually, the followingexperiment was carried out.

Recombinant wild-type LCAT protein and modified LCAT comprising a C31Ysubstitution were expressed in stably transfected CHO cells. The C31Ymodified LCAT was expressed and an Fc fusion protein, the Fc vehiclederived from either human- or Rabbit-IgG. The wild-type human proteinwas expressed with a carboxy terminal histidine (His) tag and purifiedwith affinity beads that that specifically bind this tag. The C31Ymodified LCAT-Fc protein was purified using Protein A affinity beads.Both forms of purified rLCAT proteins were solubilized in buffercontaining PBS pH 7.2, 50 μM EDTA and 10% glycerol.

Wild-type mice were fed normal chow prior to the study. Animals (n=4 pergroup) were administered a single dose of either wild-type or modifiedproteins at 10 mg/kg via IV injection and blood samples were collectedat certain time points over the following two weeks. Serum from eachsample was assessed for wild-type or modified LCAT protein content usingstandard ELISA. Protein activity was assessed by conversion ofradiolabeled cholesterol (FC) into cholesteryl ester (CE). Plasmalipids—total cholesterol (TC), high density lipoprotein C (HDL-C) andtriglycerides (TG)-were measured using a clinical analyzer.

Results indicated that the wild-type LCAT protein was isolated from CHOcells culture emdia having a molecular weight of 70 kD and an activityof 20 nmol CE/hr/μg. Wild-type protein was shown to have a half-life ofless than 30 minutes, and plasma LCAT activity within 2 hours afteradministration increased by 30 to 40%. No change was detected in plasmaHDL-C levels over the course of the study.

In contrast, the recombinant human C31Y modified LCAT protein wasisolated from the host cells culture media with a molecular weight of 95kD (monimer) and showed an activity of 200 nmol CE/hr/μg. Half-life forthe protein after administration was determined to be approximately 3days, and within 3 days after administration plasma LCAT activityincreased up to 400%. In addition, plasma HDL-C levels showedapproximately 3.5 fold increase 24 hours after administration and lastedfor about three days before returned to the basal level.

Example 5 Modified LCAT Activity Assessment

Experiments were designed to assess the ability of a modified LCATprotein to restore ApoA-I and HDL-C levels in LCAT-knockout mice (LCATknockout mice were generated as described in publication The Journal ofBiological Chemistry, 1997; 272: 15777-15781).

In brief, a group of wild type and LCAT-knockout mice (n=4 per group)were fed with normal chow before the study. Animals were then treated byIV injection of either modified recombinant human LCAT protein[rhLCAT(C31Y)-huFc] at 10 mg/kg, or vehicle buffer of equal volume (PBSpH 7.2, 50 μM EDTA, 10% glycerol). Approximately 24 hours afterinjection, animals were terminated and blood samples collected. Serumsamples were isolated from blood. Plasma LCAT activity was determined bythe conversion of radiolabeled cholesterol (FC) into cholesteryl ester(CE) with use of apoAI-proteoliposome as the substrate. Plasma apoA-1protein levels were determined by Western blotting with use ofanti-mouse apoAI antibody. Plasma lipids (TC, HDL-C and TG) weremeasured by clinical analyzer.

Results showed that treatment with the modified rhLCAT protein increasedplasma LCAT activity in wild type mice and restored plasma LCAT activityin LCAT-knockout mice. In addition, treatment with the modified rhLCATprotein restored plasma apoAI protein levels in LCAT-knockout mice toapproximately normal levels (i.e., wild-type mouse levels), as measuredwith Western Blotting. Further, treatment with the modified rhLCATprotein restored plasma HDL-C levels in LCAT-knockout mice toapproximately wild-type mouse level, as measured with clinical analyzerindicated. Finally, treatment with the modified rhLCAT proteinsuppressed the elevated TG levels in LCAT-knockout mice to the same aswild-type mouse levels with the same treatment, also as measured.

Example 6 Additional In Vivo Assessment of Modified LCAT Activity

In another series of experiments, modified rhLCAT activity was assessedin vivo to determine its effect on HDL-C levels in rabbits.

In brief, New Zealand White rabbits (body weight 2 kg each) were fedwith normal chow before the study. Animals were then randomized intothree groups with each group (n=4) receiving treatment of either vehiclebuffer (PBS pH 7.2, 50 μM EDTA, 10% glycerol), or recombinant rabbitLCAT(C31Y)-rab Fc protein dosed at 1.0 mg/kg, or 10.0 mg/kg,respectively. At the indicated time points, blood samples were collectedfor analyses. Serum samples were isolated from blood. Plasma LCATactivity was determined by the conversion of radiolabeled cholesterol(FC) into cholesteryl ester (CE) with use of apoAI-proteoliposome as thesubstrate. Plasma lipids (TC, HDL-C and TG) were measured by clinicalanalyzer. Pooled serum samples from same group of animals were used inFPLC fractionation, and cholesterol and TG contents in each fractionwere determined by clinical analyzer.

Results showed that treatment with the modified rLCAT protein rapidlyincreased plasma LCAT activity in time- and dose-dependent manners andalso robustly increased plasma HDL-C levels, also in time- anddose-dependent manners. In addition, the modified rLCAT proteinmodulated HDL particles dose-dependently and reversibly withoutincreasing plasma LDL or VLDL levels, as indicated with FPLC analysis.

Example 7 Immunogenicity Studies

Immunogenicity studies were carried out in order to determine whether amodified LCAT protein sequence would elicit an unfavorable immuneresponse in humans.

In brief, two LCAT protein peptides were assessed via in silico methodsfor their potential to induce an immune response. One peptide was 33residues in length with the wild-type LCAT amino acid sequence. Theother peptide was also 33 amino acids in length, but included a C16Ymodification of the wild-type LCAT sequence, the C16Y mutationcorresponding to the C31Y LCAT sequence mutation.

Results showed that the wild-type peptide induced a low immune response.Surprisingly, even though the mutant C16Y peptide was predicted toinduce a higher immune response, it was found that the actual immuneresponse was quite low. In view of this result, it is believed that themodified C31Y LCAT protein is unlikely to induce an anti-therapeuticresponse when administered in vivo.

The combination of data in this in other examples herein indicates thatwhile a wild-type LCAT protein is less likely to induce an immuneresponse, the higher activity of the modified LCAT protein, and the lowcapacity for the modified protein to induce an immune response, makesthe modified LCAT protein a highly desirable therapeutic alternative tothe wild-type protein.

Although the foregoing invention has been described in some detail byway of illustration and example for purposes of clarity ofunderstanding, it will be readily apparent to those of ordinary skill inthe art in light of the teachings of this invention that certain changesand modifications may be made thereto without departing from the spiritor scope of the appended claims.

1. A modified lecithin-cholesterol acyltransferase (LCAT) proteincomprising a modified form of the mature human LCAT amino acid sequenceset out in SEQ ID NO:1 or SEQ ID NO:2, wherein the modification to theLCAT protein sequence consists of a substitution at amino acid residueC31, and wherein the modified LCAT protein has increased LCAT enzymaticactivity compared to the LCAT protein of SEQ ID NO:1 or 2 as measured ina cholesterol esterification rate (CER) plasma LCAT activity assay. 2.The modified LCAT protein of claim 1 wherein the substitution atposition C31 is C31I, C31M, C31F, C31V, C31W, C31Y, C31T, C31R, or C31H.3. The modified LCAT protein of claim 2 wherein the substitution atposition C31 is C31Y.
 4. The modified LCAT protein of claim 1 furthercomprising a vehicle.
 5. The modified LCAT protein of claim 4 whereinthe vehicle is selected from the group consisting of an immunoglobulinconstant (Fc) region, a water soluble polymer, and polyethylene glycol.6. The modified LCAT protein of claim 4 wherein the vehicle is animmunoglobulin constant (Fc) region.
 7. A pharmaceutical compositioncomprising a modified LCAT protein of claim 1 and a pharmaceuticallyacceptable carrier.
 8. A method of treating a lecithin-cholesterolacyltransferase (LCAT) related disorder comprising the step ofadministering an amount of a modified LCAT protein of claim 1 in anamount effective to treat said disorder.
 9. The method of claim 8,wherein the modified LCAT (i) is administered intravenously as aninfusion, or (ii) is administered intravenously as a bolus.
 10. Themethod of claim 8, wherein the LCAT-related disorder is selected fromthe group consisting of atherosclerosis, inflammation, thrombosis,coronary heart disease, high blood pressure, LCAT deficiency syndrome,corneal opacity, dyslipidemia, myocardial infarction, stroke, criticallimb ischemia, and angina.
 11. A method for increasing HDL cholesterolin a subject comprising administering to the subject a therapeuticallyeffective amount of a modified LCAT protein of claim
 1. 12. A method fordecreasing accumulation of cholesterol in a subject comprisingadministering a therapeutically effective amount of a modified LCATprotein of claim
 1. 13. A modified lecithin-cholesterol acyltransferase(LCAT) protein comprising a modified form of the mature human LCAT aminoacid sequence set out in SEQ ID NO:1 or SEQ ID NO:2, wherein themodifications to the LCAT protein sequence consist of a substitution atamino acid residue C31 and a substitution at an amino acid residueposition selected from the group consisting of F1, L3, L4, N5, L7, N384and E416, and wherein the modified LCAT protein has increased LCATenzymatic activity compared to the LCAT protein of SEQ ID NO: 1 or 2 asmeasured in a cholesterol esterification rate (CER) plasma LCAT activityassay.
 14. The modified LCAT protein of claim 13 wherein thesubstitution at amino acid residue C31 is C31A, C31I, C31M, C31F, C31V,C31W, C31Y, C31T, C31R, or C31H and the substitution at amino acidresidue F1, L3, L4, N5, L7, N384 or E416 is F1A, F1G, F1I, F1L, F1M,F1P, F1V, F1C, F1Y, F1T, F1Q, F1N, F1H, F1D, L3I, L3F, L3C, L3W, L3Y,L4A, L4I, L4M, L4F, L4V, L4W, L4Y, L4T, L4Q, L4R, N5A, N5M, N5H, N5K,N5D, N5E, L7M, L7F, L7E, N384C, N384Q or E416C.
 15. The modified LCATprotein of claim 13 further comprising a vehicle.
 16. The modified LCATprotein of claim 15 wherein the vehicle is selected from the groupconsisting of an immunoglobulin constant (Fc) region, a water solublepolymer, and polyethylene glycol.
 17. The modified LCAT protein of claim15 wherein the vehicle is an immunoglobulin constant (Fc) region.
 18. Apharmaceutical composition comprising a modified LCAT protein of claim13 and a pharmaceutically acceptable carrier.
 19. A method of treating alecithin-cholesterol acyltransferase (LCAT) related disorder comprisingthe step of administering an amount of a modified LCAT protein of claim13 in an amount effective to treat said disorder.
 20. The method ofclaim 19, wherein the modified LCAT (i) is administered intravenously asan infusion, or (ii) is administered intravenously as a bolus.
 21. Themethod of claim 19, wherein the LCAT-related disorder is selected fromthe group consisting of atherosclerosis, inflammation, thrombosis,coronary heart disease, high blood pressure LCAT deficiency syndrome,corneal opacity, myocardial infarction, stroke, critical limb ischemia,and angina.
 22. A method for increasing HDL cholesterol in a subjectcomprising administering to the subject a therapeutically effectiveamount of a modified LCAT protein of claim
 13. 23. A method fordecreasing accumulation of cholesterol in a subject comprisingadministering a therapeutically effective amount of a modified LCATprotein of claim
 13. 24. A modified lecithin-cholesterol acyltransferase(LCAT) protein comprising a modified form of the mature human LCAT aminoacid sequence set out in SEQ ID NO:1 or SEQ ID NO:2 wherein themodifications to the LCAT protein sequence consist of a substitution atamino acid residue C31 and a substitution at an amino acid residueposition selected from the group consisting of F1, L4, N5, V28, P29,G30, L32, G33 and N34, and wherein the modified LCAT protein hasincreased LCAT enzymatic activity compared to the LCAT protein of SEQ IDNO: 1 or 2 as measured in a cholesterol esterification rate (CER) plasmaLCAT activity assay.
 25. The modified LCAT protein of claim 24 whereinthe substitution at the amino acid residue position F1, L4, N5, V28,P29, G30, L32, G33 or N34 is selected from the group consisting of F1A,L4F, N5E, N5Q, N5D, N5A, V28A, V28I, V28C, V28T, V28R, P29G, P29F, P29T,G30A, G30I, L32A, L32I, L32M, L32F, L32C, L32W, L32Y, L32T, L32S, L32N,L32H, L32E, G33I, G33M, G33F, G33S, G33H, N34A, N34C, N34S and N34R. 26.The modified LCAT protein of claim 25 wherein the C31 amino acidsubstitution is C31I, C31F, or C31Y.
 27. The modified LCAT protein ofclaim 26 wherein the C31 amino acid substitution is C31Y.
 28. Themodified LCAT protein of claim 27 wherein the substitution at F1, L4,L32 or N34 is F1S, F1W, L4M, L4K, N34S, L32F, and L32H.
 29. The modifiedLCAT protein of claim 28 , wherein the modified LCAT protein consists ofa C31Y substitution and an L4M or L4K substitution.
 30. The modifiedLCAT protein of claim 28, wherein the modified LCAT protein consists ofa C31Y substitution and an L32F substitution.
 31. The modified LCATprotein of claim 24 further comprising a vehicle.
 32. The modified LCATprotein of claim 31 wherein the vehicle is selected from the groupconsisting of an immunoglobulin constant (Fc) region, a water solublepolymer, and polyethylene glycol.
 33. The modified LCAT protein of claim31 wherein the vehicle is an immunoglobulin constant (Fc) region.
 34. Apharmaceutical composition comprising a modified LCAT protein of claim24 and a pharmaceutically acceptable carrier.
 35. A method of treating alecithin-cholesterol acyltransferase (LCAT) related disorder comprisingthe step of administering an amount of a modified LCAT protein of claim24 in an amount effective to treat said disorder.
 36. The method ofclaim 35, wherein the modified LCAT (i) is administered intravenously asan infusion, or (ii) is administered intravenously as a bolus.
 37. Themethod of claim 35, wherein the LCAT-related disorder is selected fromthe group consisting of atherosclerosis, inflammation, thrombosis,coronary heart disease, high blood pressure, LCAT deficiency syndrome,corneal opacity, dyslipidemia, myocardial infarction, stroke, criticallimb ischemia, and angina.
 38. A method for increasing HDL cholesterolin a subject comprising administering to the subject a therapeuticallyeffective amount of a modified LCAT protein of claim
 24. 39. A methodfor decreasing accumulation of cholesterol in a subject comprisingadministering a therapeutically effective amount of a modified LCATprotein of claim
 24. 40. A modified lecithin-cholesterol acyltransferase(LCAT) protein comprising a modified form of the mature human LCAT aminoacid sequence set out in SEQ ID NO:1 or SEQ ID NO:2, wherein themodifications to the LCAT protein sequence consist of a C31Ysubstitution and an N5D substitution, and wherein the modified LCATprotein has increased LCAT enzymatic activity compared to the LCATprotein of SEQ ID NO:1 or SEQ ID NO:2 as measured in a cholesterolesterification rate (CER) plasma LCAT activity assay.
 41. The modifiedLCAT protein of claim 40 further comprising a vehicle.
 42. The modifiedLCAT protein of claim 41 wherein the vehicle is selected from the groupconsisting of an immunoglobulin constant (Fc) region, a water solublepolymer, and polyethylene glycol.
 43. The modified LCAT protein of claim41 wherein the vehicle is an immunoglobulin constant (Fc) region.
 44. Apharmaceutical composition comprising a modified LCAT protein of claim40 and a pharmaceutically acceptable carrier.
 45. A method of treating alecithin-cholesterol acyltransferase (LCAT) related disorder comprisingthe step of administering an amount of a modified LCAT protein of claim40 in an amount effective to treat said disorder.
 46. The method ofclaim 45, wherein the modified LCAT (i) is administered intravenously asan infusion, or (ii) is administered intravenously as a bolus.
 47. Themethod of claim 45, wherein the LCAT-related disorder is selected fromthe group consisting of atherosclerosis, inflammation, thrombosis,coronary heart disease, high blood pressure LCAT deficiency syndrome,corneal opacity, dyslipidemia, myocardial infarction, stroke, criticallimb ischemia, and angina.
 48. A method for increasing HDL cholesterolin a subject comprising administering to the subject a therapeuticallyeffective amount of a modified LCAT protein of claim
 40. 49. A methodfor decreasing accumulation of cholesterol in a subject comprisingadministering a therapeutically effective amount of a modified LCATprotein of claim
 40. 50. A modified lecithin-cholesterol acyltransferase(LCAT) protein comprising a modified form of the mature human LCAT aminoacid sequence set out in SEQ ID NO:1 or SEQ ID NO:2, wherein themodifications to the LCAT protein sequence consist of a C31Ysubstitution and an L4W substitution, and wherein the modified LCATprotein has increased LCAT enzymatic activity compared to the LCATprotein of SEQ ID NO:1 or SEQ ID NO:2 as measured in a cholesterolesterification rate (CER) plasma LCAT activity assay.
 51. The modifiedLCAT protein of claim 50 further comprising a vehicle.
 52. The modifiedLCAT protein of claim 51 wherein the vehicle is selected from the groupconsisting of an immunoglobulin constant (Fc) region, a water solublepolymer, and polyethylene glycol.
 53. The modified LCAT protein of claim51 wherein the vehicle is an immunoglobulin constant (Fc) region.
 54. Apharmaceutical composition comprising a modified LCAT protein of claim50 and a pharmaceutically acceptable carrier.
 55. A method of treating alecithin-cholesterol acyltransferase (LCAT) related disorder comprisingthe step of administering an amount of a modified LCAT protein of claim50 in an amount effective to treat said disorder.
 56. The method ofclaim 55, wherein the modified LCAT (i) is administered intravenously asan infusion, or (ii) is administered intravenously as a bolus.
 57. Themethod of claim 55, wherein the LCAT-related disorder is selected fromthe group consisting of atherosclerosis, inflammation, thrombosis,coronary heart disease, high blood pressure, LCAT deficiency syndrome,corneal opacity, dyslipidemia, myocardial infarction, stroke, criticallimb ischemia, and angina.
 58. A method for increasing HDL cholesterolin a subject comprising administering to the subject a therapeuticallyeffective amount of a modified LCAT protein of claim
 50. 59. A methodfor decreasing accumulation of cholesterol in a subject comprisingadministering a therapeutically effective amount of a modified LCATprotein of claim
 50. 60. A modified lecithin-cholesterol acyltransferase(LCAT) protein comprising a modified form of the mature human LCAT aminoacid sequence set out in SEQ ID NO:1 or SEQ ID NO:2, wherein themodifications to the LCAT protein sequence consist of a C31Ysubstitution, an L4F substitution and an N5D substitution, and whereinthe modified LCAT protein has increased LCAT enzymatic activity comparedto the LCAT protein of SEQ ID NO:1 or SEQ ID NO:2 as measured in acholesterol esterification rate (CER) plasma LCAT activity assay. 61.The modified LCAT protein of claim 60 further comprising a vehicle. 62.The modified LCAT protein of claim 61 wherein the vehicle is selectedfrom the group consisting of an immunoglobulin constant (Fc) region, awater soluble polymer, and polyethylene glycol.
 63. The modified LCATprotein of claim 61 wherein the vehicle is an immunoglobulin constant(Fc) region.
 64. A pharmaceutical composition comprising a modified LCATprotein of claim 60 and a pharmaceutically acceptable carrier.
 65. Amethod of treating a lecithin-cholesterol acyltransferase (LCAT) relateddisorder comprising the step of administering an amount of a modifiedLCAT protein of claim 60 in an amount effective to treat said disorder.66. The method of claim 65, wherein the modified LCAT (i) isadministered intravenously as an infusion, or (ii) is administeredintravenously as a bolus.
 67. The method of claim 65, wherein theLCAT-related disorder is selected from the group consisting ofatherosclerosis, inflammation, thrombosis, coronary heart disease, highblood pressure, LCAT deficiency syndrome, corneal opacity, dyslipidemia,myocardial infarction, stroke, critical limb ischemia, and angina.
 68. Amethod for increasing HDL cholesterol in a subject comprisingadministering to the subject a therapeutically effective amount of amodified LCAT protein of claim
 60. 69. A method for decreasingaccumulation of cholesterol in a subject comprising administering atherapeutically effective amount of a modified LCAT protein of claim 60.